Syncope / Fainting in Children: Advice for Referrers

RHC for Health Professionals
NHS GGC

Syncope, or fainting is common, occurring in approximately 15-20% of children and young people,1,2 most causes of syncope are benign.

The classical presentation of syncope often has a trigger, followed by a prodromal phase where the individual can experience dizziness, visual disturbances, temperature change and pallor. This is typically followed by a brief loss of consciousness (< 1 minute), which may be accompanied by limb twitching.  Most patients will recover within 15 minutes but can feel tired thereafter.

Common Syncope Triggers

Physical Triggers

 

Heat, Humidity – shower, bath

Prolonged standing

Change in position e.g. Lying to standing

Hair brushing

Dehydration

Emotional Triggers

Sight of Blood

Pain

Fear, Anxiety

Who NOT to refer

Not all syncope requires a referral to secondary care:

Who NOT to refer

  • Single event with classical history
  • Recurrent events syncope if clear trigger has been identified and not increasing in intensity or frequency

Useful patient resources are linked below.

Indications for referral

If the patient has a known cardiac condition, please refer/discuss directly with Paediatric Cardiology (DECT phone 84440)

Please refer the follow patients to Medical Paediatrics:

  • Long duration of loss of consciousness
  • Increasing frequency and intensity of syncopal episode
  • Unclear history – i.e. not following a classical history
  • Other symptoms
  • Symptoms between events

Referral to Paediatric Neurology:

  • Features of a seizure

Referral to Paediatric Cardiology:

  • Known cardiac disease/under cardiac follow up
  • Fainting during exercise
  • Family history of sudden death or inherited cardiac arrhythmia
  • Fainting when lying down
  • Syncope after hearing loud or emotional distress

Helpful points to include in referral letter

General:

  • Summary of witness account of the episode(s) if possible
  • Features including duration, incontinence, shaking, and colour change
  • Recovery time?
  • How many and frequency of episodes?
  • Any related symptoms e.g., shortness of breath, chest pain, palpitations?
  • Any other red flags noted on history or examination
  • Child’s general health and wellbeing

Patient Background:

  • 1st degree relatives with syncope, cardiac problems, and epilepsy or seizures
  • Relevant past medical history/ medications

Events Surrounding Episode(s):

  • Prodromal symptoms (e.g. dizziness, nausea, visual disturbance)
  • Circumstances surrounding episode(s) e.g. prolonged periods of standing, emotional triggers, temperature
  • If multiple events, did these have similar circumstances or triggers?

Examination

  1. Positive findings from cardiac or neurological examination
  2. Child’s height and weight
  3. Are they developing appropriately?

Management whilst awaiting outpatient appointment

  • If the episode is related to exercise, the child should avoid strenuous exercise/unsupervised swimming while awaiting an outpatient appointment
  • Provide education for parents on what to do in case their child feels like this again, how to avoid faints and what to do if their child faints (see below)
  • Have parents or older children keep a diary of any future episodes of syncope and the circumstances surrounding these
  • If possible, consider blood tests to check for any potential causes e.g. Anaemia, TFT’s and treat if found. (Appointments for paediatric phlebotomy can be sent from RHC. Please refer to medical paediatrics asking for blood tests this will be appointed for phlebotomy only)

Useful resources for Parents

Syncope in Children and Young People

General Information on Fainting

Management of Fainting and Associated Symptoms

Useful resources for GPs

KA McLeod, Syncope in Childhood. Arch Dis Child 2003;88:350–353.

Harris M, Bu’Lock F. Fifteen-minute consultation on Limiting Investigations in the Fainting Child. Arch Dis Child Educ Pract Ed 2016;101:26–30.

References

  1. KA McLeod, Syncope in Childhood. Arch Dis Child 2003;88:350–353. Accessed on 9th July 2025.
  2. Harris M, Bu’Lock F. Fifteen-minute consultation on Limiting Investigations in the Fainting Child. Arch Dis Child Educ Pract Ed 2016;101:26–30. Accessed on 9th July 2025.
  3. NHS Kingston and Richmond Foundation Trust, Syncope (fainting) in Children and Young People. 9th December 2024, accessed on 15th July 2025. 
  4. NHS Leeds Teaching Hospitals. Faints, dizziness, palpitations and chest pain in children and young people. 4th June 2025, accessed on 15th July 2025. 
  5. NHS Greater Glasgow and Clyde, Advice for Patients Who Tend to Faint. August 2023, accessed on 15th July 2025. 

Editorial Information

Last reviewed: 28/01/2026

Next review date: 31/01/2029

Author(s): Amy Stewart, Medical Student, Laura Mclaren, Consultant Paediatrician (corresponding author).

Co-Author(s): Karen Macleod, Consultant in Paediatric Cardiology.

Approved By: Medical Paediatrics