Fainting in children

Fainting in children (Greek synkope - loss of sound) is a sudden, sharp deterioration in well-being, accompanied by vegetative-vascular disorders, short-term loss of consciousness, decreased muscle tone and a fall.

Most often, fainting is observed in school-age children, which reflects the imperfection of the autonomic regulation of vascular tone during puberty.

[ 1 ], [ 2 ]

Causes of Fainting in Children

The occurrence of fainting in children is associated with an acute disorder of brain metabolism due to its deep hypoxia or hypoglycemia. Usually, a reflex neurogenic spasm of the cerebral vessels and an accompanying parasympathetic effect (n. vagus) on the heart and blood vessels are noted, which is accompanied by a sharp decrease in the tone of peripheral vessels, bradycardia.

E. N. Ostapenko (1995) identifies the following most common types of fainting in children, caused by a primary disturbance in the regulation of the cardiovascular system:

• vasodepressive syncope in children occurs most often (usually in connection with a stressful situation, for example, during a medical procedure - an injection);
• Orthostatic hypotension - functional (due to a sedentary lifestyle) and organic (against the background of diabetes mellitus, amyloidosis, CNS tumors, etc.); caused by insufficiency of vasopressor mechanisms;
• reflex fainting in children develops in response to manipulations on reflexogenic zones (throat, larynx, bronchi, carotid sinus, etc.) and is associated with irritation of the vagus nerve. Carotid sinus syndrome can occur with mechanical irritation (by palpation) in the area of the projection of the carotid artery bifurcation and be cardioinhibitory and vasodepressor in the form of response;
• situational fainting in children occurs during a coughing fit, straining during defecation or difficulty urinating, lifting something heavy due to a sharp increase in intrathoracic pressure, which impedes the outflow of blood from the brain;
• Hyperventilation syndrome develops most often in hysteria; fainting itself in children is caused by secondary respiratory alkalosis, hypocapnia, spasm of cerebral vessels and its ischemia.

[ 3 ], [ 4 ], [ 5 ], [ 6 ]

How does fainting manifest itself in children?

In the clinical picture of fainting in children, three successive stages can be observed: the appearance of precursors (pre-fainting state), impaired consciousness and the recovery period.

At first, subjective sensations arise in the form of discomfort, increasing weakness, dizziness, darkening of the vision (gray veil), noise in the ears, spasmodic pain in the abdomen, increased sweating, decreased muscle tone. The duration of this stage does not exceed 1 minute (usually a few seconds). In case of timely measures (lying down, getting access to fresh air) it is possible to prevent loss of consciousness.

The unconscious state during fainting lasts for several minutes, rarely longer. During this period, the child exhibits pale skin, dilated pupils without reaction to light, bradycardia, decreased blood pressure, respiratory depression (it becomes shallow and rare), suppression of reflexes (including corneal), and relaxation of all muscles.

The diagnosis of fainting is based on a typical clinical picture. It occurs suddenly, usually when the child is in an upright position, in a certain situation (stuffiness, tightness, fuss, stress).

There may be other reasons for the genesis of sudden loss of consciousness with a fall: complete AV block of the heart (Morgagni-Adams-Stokes syndrome), epilepsy (minor forms), embolization of cerebral vessels, cerebrovascular accident, severe anemia, etc. Therefore, a thorough differential diagnosis is necessary both during the provision of assistance to the child during fainting and afterwards to exclude organic pathology.

What to do if a child faints?

Help for a child who faints is aimed at improving the blood supply to the brain. In no case should a child who has suddenly lost consciousness be supported in a vertical or sitting position - he should be laid down with his legs slightly raised. If a child faints, he usually does not get hurt. The patient needs to unbutton his collar, provide access to fresh air, bring a cotton ball soaked in ammonia (10% aqueous ammonia solution) to his nose, splash his face with cold water, and lightly pat his cheeks. Fainting in children can also be treated with subcutaneous injections of cordiamine, caffeine (25%) at a dose of 0.1 ml for each year of life.