Management of syncope in pediatric patients.

Syncope is a common symptom in children, particularly in the teenage years. Although most often benign, it can be a symptom of serious underlying conditions and may result in sudden death. It is estimated that approximately 1% to 2% of children presenting with syncope have a serious underlying disorder. Therefore, it is important to assess patients logically and be able to separate those with serious pathology from those without. A good history is the most important step in this regard, and can save a significant amount of anxiety, time, and money for the patient and for the health care system. Most patients can be determined to have vasovagal syncope on the basis of a good history, physical examination, and standard electrocardiogram. Other tests, such as echocardiography and electrocardiogram monitoring (eg, Holter/event monitors, including implantable event monitors), may be reserved for those with abnormalities in the initial workup. Therapy depends on the underlying disorder. Vasovagal syncope may only need reassurance and volume loading with increase in salt and water intake.