Shaping better health
REMEDY : BNSSG referral pathways & Joint Formulary


Home > Children & Young People > Cardiology >

Syncope in Children

Checked: 19-04-2024 by 5 Rob Adams Next Review: 17-04-2026

Overview

Refer to the Fits, Faints and Funny Turns - referral pathway (1) provided by Bristol Royal Hospital for Children.

Before Referral

All children with a syncopal episode should have a detailed history and examination (1)

History
A detailed history of the event is the best strategy to determine the cause of syncope and guide further investigation with eye witness or video accounts where possible. Describe the details of the event including:
  • Health: Was the baby/child well at the time of onset?
  • Prodromal symptoms: Were there any pre-syncopal symptoms such as dizziness, nausea or headache for example?
  • Triggers: Were there any specific triggers preceding syncope (e.g. exercise, postural change, skipping meals, emotional distress or pain)?
  • Duration: How long did the episode last?
  • Nature of movements: Note the nature of any limb, facial, and head movements during the episode.
  • Truncal and limb tone: Describe any changes in truncal and limb tone or posture.
  • Any focal symptoms: Determine if there was any focal abnormality during the episode.
  • Recovery: Assessment of post-syncopal symptoms and speed of recovery i.e. time until the child was responsive again
  • Anything relevant leading up to the event (the context in which it occurred: infection
  • (Pyrexia, Diarrhoea, Vomiting, Rash), Pain, Headache, Vomiting, Drowsiness, Raised
  • ICP, palpitations, Injury
Background history including: age, birth history, development, family history (including
of epilepsy and sudden death), behavioural disturbance or regression, previous events
and past medical history and drug history.

Examination

Full examination including neurological and cardiovascular systems, look for signs of
injury or non-accidental injury.

Investigation

  • All children with loss of consciousness need Glucose, ECG, and Blood Pressure.
  • All children with syncope also need a lying and standing blood pressure in addition to
    above investigations

ECG in primary care

Non-acute ECGs for children should normally be undertaken in primary care.

There is no specific ecg service in secondary care for children and the adult ecg service will only accept referrals for patients aged 16 and over.

If interpretation of an ecg done in primary care is required then consider using paediatric advice and guidance.

If emergency/same day interpretation is required then consider the Urgent Care Referrals page or discuss with on call paediatric cardiologist.

Referral

Indications for referral to General Paediatric clinic via eRS:
• Younger children (under 8yrs) who have unprovoked syncopal episodes
• Any other undifferentiated episodes causing concern

Indications For Cardiology Referral via eRS or same day discussion if red flags:
• Syncope during exercise or when supine
• Family history of sudden death, prolonged QT syndrome or hypertrophic cardiomyopathy.
• Syncope preceded by palpitations.
• Syncope in a child with known congenital heart disease.
• Heart murmur or other abnormalities on cardiovascular examination or ECG

Resources

NICE guidelines

Recommendations for children aged under 16 | Suspected neurological conditions: recognition and referral |



Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.