Skip to main content

Advertisement

SpringerLink
Log in

Loss of Consciousness in the Young Child

  • Review Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

In the very young child (less than eight years of age), transient loss of consciousness represents a diagnostic and management dilemma for clinicians. While most commonly benign, syncope may be due to cardiac dysfunction which can be life-threatening. It can be secondary to an underlying ion channelopathy, cardiac inflammation, cardiac ischemia, congenital heart disease, cardiomyopathy, or pulmonary hypertension. Patients with genetic disorders require careful evaluation for a cardiac cause of syncope. Among the noncardiac causes, vasovagal syncope is the most common etiology. Breath-holding spells are commonly seen in this age group. Other causes of transient loss of consciousness include seizures, neurovascular pathology, head trauma, psychogenic pseudosyncope, and factitious disorder imposed on another and other forms of child abuse. A detailed social, present, past medical, and family medical history is important when evaluating loss of consciousness in the very young. Concerning characteristics of syncope include lack of prodromal symptoms, no preceding postural changes or occurring in a supine position, after exertion or a loud noise. A family history of sudden unexplained death, ion channelopathy, cardiomyopathy, or congenital deafness merits further evaluation. Due to inherent challenges in diagnosis at this age, often there is a lower threshold for referral to a specialist.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Adapted from Cannon. B., Wackel. P. Syncope. Pediatr Rev. 2016 37(4):159–67 [139]

Similar content being viewed by others

Abbreviations

AV:

Atrioventricular

BRUE:

Brief resolved unexplained event

CHD:

Congenital heart disease

CMP:

Cardiomyopathy

CPVT:

Catecholaminergic Polymorphic Ventricular Tachycardia

EKG:

Electrocardiogram

LOC:

Loss of consciousness

LQTS:

Long QT syndrome

PHTN:

Pulmonary hypertension

TGA:

Transposition of the great arteries

ToF:

Tetralogy of fallot

SCD:

Sudden cardiac death

WPW:

Wolff–Parkinson–White syndrome

References

  1. Kochilas L, Tanel RE (2001) Evaluation and treatment of syncope in infants. Prog Pediatr Cardiol 13(2):71–82

    Article  CAS  PubMed  Google Scholar 

  2. Moya A et al (2009) Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 30(21):2631–2671

    Article  PubMed  PubMed Central  Google Scholar 

  3. Njemanze PC (1993) Cerebral circulation dysfunction and hemodynamic abnormalities in syncope during upright tilt test. Can J Cardiol 9(3):238–242

    CAS  PubMed  Google Scholar 

  4. Brignole M et al (2018) ESC guidelines for the diagnosis and management of syncope. Eur Heart J 39(21):1883–1940

    Article  PubMed  Google Scholar 

  5. Driscoll DJ et al (1997) Syncope in children and adolescents. J Am Coll Cardiol 29(5):1039–1045

    Article  CAS  PubMed  Google Scholar 

  6. Shen WK et al (2017) ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: executive summary: a report of the american college of cardiology/american heart association task force on clinical practice guidelines and the heart rhythm society. J Am Coll Cardiol 70(5):620–663

    Article  PubMed  Google Scholar 

  7. Kanjwal K, Masudi S, Grubb BP (2015) Syncope in children and adolescents. Adolesc Med State Art Rev 26(3):692–711

    PubMed  Google Scholar 

  8. Massin MM et al (2004) Syncope in pediatric patients presenting to an emergency department. J Pediatr 145(2):223–228

    Article  PubMed  Google Scholar 

  9. Wren C (1999) Cardiac causes for syncope or sudden death in childhood. Arch Dis Child 81(4):289–291

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Johnson ER et al (2014) Practice variation and resource use in the evaluation of pediatric vasovagal syncope: are pediatric cardiologists over-testing? Pediatr Cardiol 35(5):753–758

    Article  PubMed  Google Scholar 

  11. Berger S, Dhala A, Friedberg DZ (1999) Sudden cardiac death in infants, children, and adolescents. Pediatr Clin North Am 46(2):221–234

    Article  CAS  PubMed  Google Scholar 

  12. Liberthson RR (1996) Sudden death from cardiac causes in children and young adults. N Engl J Med 334(16):1039–1044

    Article  CAS  PubMed  Google Scholar 

  13. Maron BJ et al (1996) Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles. JAMA 276(3):199–204

    Article  CAS  PubMed  Google Scholar 

  14. Johnsrude CL (2000) Current approach to pediatric syncope. Pediatr Cardiol 21(6):522–531

    Article  CAS  PubMed  Google Scholar 

  15. Zhang Q et al (2009) The diagnostic protocol in children and adolescents with syncope: a multi-centre prospective study. Acta Paediatr 98(5):879–884

    Article  PubMed  Google Scholar 

  16. Kouakam C et al (2001) Long-term follow-up of children and adolescents with syncope; predictor of syncope recurrence. Eur Heart J 22(17):1618–1625

    Article  CAS  PubMed  Google Scholar 

  17. Vlahos AP, Kolettis TM (2008) Family history of children and adolescents with neurocardiogenic syncope. Pediatr Cardiol 29(1):227

    Article  PubMed  Google Scholar 

  18. Lucet V, de Bethmann O, Denjoy I (2000) Paroxysmal vagal overactivity, apparent life-threatening event and sudden infant death. Biol Neonate 78(1):1–7

    Article  CAS  PubMed  Google Scholar 

  19. Igarashi M et al (1988) Syncope associated with hair-grooming. Brain Dev 10(4):249–251

    Article  CAS  PubMed  Google Scholar 

  20. Anderson JB et al (2016) The evaluation and management of pediatric syncope. Pediatr Neurol 55:6–13

    Article  PubMed  Google Scholar 

  21. Fenrich A, Denfield SW, Garson A Jr (1994) Sudden Death in Children. In: Akhtar M, Myerburg RJ, Ruskin J (eds) Sudden cardiac death: prevalence, mechanisms, and approaches to diagnosis and management. Williams & Wilkins, New York, NY, pp 258–273

    Google Scholar 

  22. Driscoll DJ, Edwards WD (1985) Sudden unexpected death in children and adolescents. J Am Coll Cardiol 5(6 Suppl):118B-121B

    Article  CAS  PubMed  Google Scholar 

  23. DiMario FJ Jr (2001) Prospective study of children with cyanotic and pallid breath-holding spells. Pediatrics 107(2):265–269

    Article  PubMed  Google Scholar 

  24. Taiwo B, Hamilton AH (1993) Cardiac arrest: a rare complication of pallid syncope? Postgrad Med J 69(815):738–739

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Courtheix M et al (2016) Syncope unit in the paediatric population: a single-centre experience. Arch Cardiovasc Dis 109(3):199–206

    Article  PubMed  Google Scholar 

  26. Kouakam C et al (2002) Prevalence and prognostic significance of psychiatric disorders in patients evaluated for recurrent unexplained syncope. Am J Cardiol 89(5):530–535

    Article  PubMed  Google Scholar 

  27. Tannemaat MR, Thijs RD, van Dijk JG (2014) Managing psychogenic pseudosyncope: facts and experiences. Cardiol J 21(6):658–664

    Article  PubMed  Google Scholar 

  28. Saal DP et al (2016) Long-term follow-up of psychogenic pseudosyncope. Neurology 87(21):2214–2219

    Article  PubMed  PubMed Central  Google Scholar 

  29. LaFrance WC Jr et al (2014) Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry 71(9):997–1005

    Article  PubMed  Google Scholar 

  30. Raj V et al (2014) Psychogenic pseudosyncope: diagnosis and management. Auton Neurosci 184:66–72

    Article  PubMed  Google Scholar 

  31. Benbadis SR, Chichkova R (2006) Psychogenic pseudosyncope: an underestimated and provable diagnosis. Epilepsy Behav 9(1):106–110

    Article  PubMed  Google Scholar 

  32. Meadow R (1985) Management of munchausen syndrome by proxy. Arch Dis Child 60(4):385–393

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Victor, M.R., Allan, Adams and Victor’s Principles of Neurology 7th edition. Vol. 7th edition. 2000: McGraw-Hill Professional.

  34. Wolff GS (1997) Unexplained syncope: clinical management. Pacing Clin Electrophysiol 20(8 Pt 2):2043–2047

    Article  CAS  PubMed  Google Scholar 

  35. Michaelsson M, Engle MA (1972) Congenital complete heart block: an international study of the natural history. Cardiovasc Clin 4(3):85–101

    CAS  PubMed  Google Scholar 

  36. Clark JB et al (2010) Resolution of heart block after surgical removal of an amplatzer device. Ann Thorac Surg 89(5):1631–1633

    Article  PubMed  Google Scholar 

  37. Wallis GA, Debich-Spicer D, Anderson RH (2011) Congenitally corrected transposition. Orphanet J Rare Dis 6:22

    Article  PubMed  PubMed Central  Google Scholar 

  38. Cardell BS (1956) Corrected transposition of the great vessels. Br Heart J 18(2):186–192

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Friedberg DZ, Nadas AS (1970) Clinical profile of patients with congenital corrected transposition of the great arteries. A study of 60 cases. N Engl J Med 282(19):1053–1059

    Article  CAS  PubMed  Google Scholar 

  40. Huhta JC et al (1983) Complete atrioventricular block in patients with atrioventricular discordance. Circulation 67(6):1374–1377

    Article  CAS  PubMed  Google Scholar 

  41. Chavda KK et al (2004) Seizures secondary to a high-grade atrioventricular block as a presentation of acute myocarditis. Pediatr Emerg Care 20(6):387–390

    Article  PubMed  Google Scholar 

  42. Klein GJ et al (1979) Ventricular fibrillation in the Wolff-Parkinson-White syndrome. N Engl J Med 301(20):1080–1085

    Article  CAS  PubMed  Google Scholar 

  43. Deal B et al (1995) Cardiac arest in young patients with Wolff-Parkinson-White syndrome. PACE 18:815

    Google Scholar 

  44. Villain E et al (1990) Evolving concepts in the management of congenital junctional ectopic tachycardia. A multicenter study. Circulation 81(5):1544–1549

    Article  CAS  PubMed  Google Scholar 

  45. Garson A Jr et al (1987) Incessant ventricular tachycardia in infants: myocardial hamartomas and surgical cure. J Am Coll Cardiol 10(3):619–626

    Article  PubMed  Google Scholar 

  46. Geggel RL, McInerny J, Estes NA 3rd (1989) Transient neonatal ventricular tachycardia associated with maternal cocaine use. Am J Cardiol 63(5):383–384

    Article  CAS  PubMed  Google Scholar 

  47. Frassica JJ et al (1994) Arrhythmias in children prenatally exposed to cocaine. Arch Pediatr Adolesc Med 148(11):1163–1169

    Article  CAS  PubMed  Google Scholar 

  48. Chasnoff IJ, Lewis DE, Squires L (1987) Cocaine intoxication in a breast-fed infant. Pediatrics 80(6):836–838

    CAS  PubMed  Google Scholar 

  49. Schwartz PJ et al (2009) Prevalence of the congenital long-QT syndrome. Circulation 120(18):1761–1767

    Article  PubMed  PubMed Central  Google Scholar 

  50. Goldenberg I, Moss AJ (2008) Long QT syndrome. J Am Coll Cardiol 51(24):2291–2300

    Article  PubMed  Google Scholar 

  51. Ackerman MJ et al (2011) HRS/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies this document was developed as a partnership between the heart rhythm society (HRS) and the european heart rhythm association (EHRA). Heart Rhythm 8(8):1308–1339

    Article  PubMed  Google Scholar 

  52. Ackerman MJ (1998) The long QT syndrome: ion channel diseases of the heart. Mayo Clin Proc 73(3):250–269

    Article  CAS  PubMed  Google Scholar 

  53. Take Y et al (2012) Identification of high-risk syncope related to ventricular fibrillation in patients with brugada syndrome. Heart Rhythm 9(5):752–759

    Article  PubMed  Google Scholar 

  54. Villafane J et al (2013) Long-term follow-up of a pediatric cohort with short QT syndrome. J Am Coll Cardiol 61(11):1183–1191

    Article  PubMed  Google Scholar 

  55. Lupoglazoff JM et al (2004) Long QT syndrome in neonates: conduction disorders associated with HERG mutations and sinus bradycardia with KCNQ1 mutations. J Am Coll Cardiol 43(5):826–830

    Article  CAS  PubMed  Google Scholar 

  56. Lupoglazoff JM et al (2001) Homozygous SCN5A mutation in long-QT syndrome with functional two-to-one atrioventricular block. Circ Res 89(2):E16-21

    Article  CAS  PubMed  Google Scholar 

  57. Dufendach KA et al (2017) Clinical outcomes and modes of death in timothy syndrome. JACC 44(4):459–466

    Google Scholar 

  58. Hoover CA et al (1996) Cardiac arrest associated with combination cisapride and itraconazole therapy. J Cardiovasc Pharmacol Ther 1(3):255–258

    Article  CAS  PubMed  Google Scholar 

  59. Drici MD, Barhanin J (2000) Cardiac K+ channels and drug-acquired long QT syndrome. Therapie 55(1):185–193

    CAS  PubMed  Google Scholar 

  60. Rohatgi RK, Bos JM, Ackerman MJ (2015) Stimulant therapy in children with attention-deficit/hyperactivity disorder and concomitant long QT syndrome: a safe combination? Heart Rhythm 12(8):1807–1812

    Article  PubMed  PubMed Central  Google Scholar 

  61. Yoshinaga M et al (2011) The QT intervals in infancy and time for infantile ECG screening for long QT syndrome. J Arrhythmia 27(3):193–201

    Article  Google Scholar 

  62. Phan DQ et al (2015) Comparison of formulas for calculation of the corrected QT interval in infants and young children. J Pediatr 166(4):960–964

    Article  PubMed  PubMed Central  Google Scholar 

  63. Leenhardt A et al (1995) Catecholaminergic polymorphic ventricular tachycardia in children A 7-year follow-up of 21 patients. Circulation 91(5):1512–1519

    Article  CAS  PubMed  Google Scholar 

  64. Roston TM et al (2015) Catecholaminergic polymorphic ventricular tachycardia in children: analysis of therapeutic strategies and outcomes from an international multicenter registry. Circ Arrhythm Electrophysiol 8(3):633–642

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Hayashi M et al (2012) The role of stress test for predicting genetic mutations and future cardiac events in asymptomatic relatives of catecholaminergic polymorphic ventricular tachycardia probands. Europace 14(9):1344–1351

    Article  PubMed  Google Scholar 

  66. Villafane J et al (2009) Short QT syndrome in a pediatric patient. Pediatr Cardiol 30(6):846–850

    Article  PubMed  Google Scholar 

  67. Gussak I et al (2000) Idiopathic short QT interval: a new clinical syndrome? Cardiology 94(2):99–102

    Article  CAS  PubMed  Google Scholar 

  68. Villafane J, Fischbach P, Gebauer R (2014) Short QT syndrome manifesting with neonatal atrial fibrillation and bradycardia. Cardiology 128(3):236–240

    Article  PubMed  Google Scholar 

  69. Juang JJ, Horie M (2016) Genetics of brugada syndrome. J Arrhythm 32(5):418–425

    Article  PubMed  PubMed Central  Google Scholar 

  70. Brugada P, Brugada J (1992) Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol 20(6):1391–1396

    Article  CAS  PubMed  Google Scholar 

  71. Harris BU et al (2014) Diagnosis and management of pediatric brugada syndrome: a survey of pediatric electrophysiologists. Pacing Clin Electrophysiol 37(5):638–642

    Article  PubMed  Google Scholar 

  72. Antzelevitch C (2006) Brugada syndrome. Pacing Clin Electrophysiol 29(10):1130–1159

    Article  PubMed  PubMed Central  Google Scholar 

  73. Brugada, R., et al. 1993 Brugada Syndrome, in GeneReviews((R)), M.P. Adam, et al. (Eds) Seattle (WA).

  74. Gonzalez Corcia MC et al (2016) Brugada syndrome in the paediatric population: a comprehensive approach to clinical manifestations, diagnosis, and management. Cardiol Young 26(6):1044–1055

    Article  PubMed  Google Scholar 

  75. Antzelevitch C et al (2005) Brugada syndrome: from cell to bedside. Curr Probl Cardiol 30(1):9–54

    Article  PubMed  PubMed Central  Google Scholar 

  76. Driscoll DJ 2006 Chapter 10: Right-to-Left Shunts, in Fundamentals of Pediatric Cardiology. Lippincott Williams & Wilkins.

  77. Roche, L., S. Greenway, A. Redington 2013 Chapter 43: Tetralogy of Fallot with Pulmonary Stenosis and Tetralogy of Fallow with Absent Pulmonary Valve, in Moss and Adams Heart Disease in Infants, Children, and Adolescents: Including the Fetus and Young Adult, H.D. Allen, et al. (eds), Lippincott Williams & Wilkins.

  78. Lillehei CW et al (1963) Chronic postsurgical complete heart block. With particular reference to prognosis, management, and a new P-wave pacemaker. J Thorac Cardiovasc Surg 46:436–456

    Article  CAS  PubMed  Google Scholar 

  79. Weindling SN et al (1998) Duration of complete atrioventricular block after congenital heart disease surgery. Am J Cardiol 82(4):525–527

    Article  CAS  PubMed  Google Scholar 

  80. Hayashi G et al (2006) Prevalence of arrhythmias and their risk factors mid- and long-term after the arterial switch operation. Pediatr Cardiol 27(6):689–694

    Article  PubMed  Google Scholar 

  81. Knight BP et al (1999) Outcome of patients with nonischemic dilated cardiomyopathy and unexplained syncope treated with an implantable defibrillator. J Am Coll Cardiol 33(7):1964–1970

    Article  CAS  PubMed  Google Scholar 

  82. Elliott PM et al (2000) Sudden death in hypertrophic cardiomyopathy: identification of high risk patients. J Am Coll Cardiol 36(7):2212–2218

    Article  CAS  PubMed  Google Scholar 

  83. Towbin JA et al (2006) Incidence, causes, and outcomes of dilated cardiomyopathy in children. JAMA 296(15):1867–1876

    Article  CAS  PubMed  Google Scholar 

  84. Hershberger RE et al (2009) Progress with genetic cardiomyopathies: screening, counseling, and testing in dilated, hypertrophic, and arrhythmogenic right ventricular dysplasia/cardiomyopathy. Circ Heart Fail 2(3):253–261

    Article  PubMed  PubMed Central  Google Scholar 

  85. McKenna WJ, Goodwin JF (1981) The natural history of hypertrophic cardiomyopathy. Curr Probl Cardiol 6(4):1–26

    Article  CAS  PubMed  Google Scholar 

  86. Colan SD (2010) Hypertrophic cardiomyopathy in childhood. Heart Fail 6(4):433–444

    Article  Google Scholar 

  87. Minakata K et al (2005) Septal myectomy for obstructive hypertrophic cardiomyopathy in pediatric patients: early and late results. Ann Thorac Surg 80(4):1424–1429

    Article  PubMed  Google Scholar 

  88. Altarabsheh SE et al (2013) Outcome of septal myectomy for obstructive hypertrophic cardiomyopathy in children and young adults. Ann Thorac Surg 95(2):663–669

    Article  PubMed  Google Scholar 

  89. Williams L, Frenneaux M (2007) Syncope in hypertrophic cardiomyopathy: mechanisms and consequences for treatment. Europace 9(9):817–822

    Article  PubMed  Google Scholar 

  90. Lipshultz SE et al (2013) Pediatric cardiomyopathies: causes, epidemiology, clinical course, preventive strategies and therapies. Future Cardiol 9(6):817–848

    Article  CAS  PubMed  Google Scholar 

  91. Denfield SW, Webber SA (2010) Restrictive cardiomyopathy in childhood. Heart Fail Clin 6(4):445–452

    Article  PubMed  Google Scholar 

  92. Stanton C et al (2009) Isolated left ventricular noncompaction syndrome. Am J Cardiol 104(8):1135–1138

    Article  PubMed  Google Scholar 

  93. Stollberger C, Finsterer J (2010) Arrhythmias and left ventricular hypertrabeculation /noncompaction. Curr Pharm Des 16(26):2880–2894

    Article  CAS  PubMed  Google Scholar 

  94. Hamid MS et al (2002) Prospective evaluation of relatives for familial arrhythmogenic right ventricular cardiomyopathy/dysplasia reveals a need to broaden diagnostic criteria. J Am Coll Cardiol 40(8):1445–1450

    Article  PubMed  Google Scholar 

  95. Zhang L et al (2014) The electrocardiographic manifestations of arrhythmogenic right ventricular dysplasia. Curr Cardiol Rev 10(3):237–245

    Article  PubMed  PubMed Central  Google Scholar 

  96. Freedom RM et al (2000) Selected aspects of cardiac tumors in infancy and childhood. Pediatr Cardiol 21(4):299–316

    Article  CAS  PubMed  Google Scholar 

  97. Meissner C et al (2000) Sudden unexpected infant death due to fibroma of the heart. J Forensic Sci 45(3):731–733

    Article  CAS  PubMed  Google Scholar 

  98. Van der Hauwaert LG (1971) Cardiac tumours in infancy and childhood. Br Heart J 33(1):125–132

    Article  PubMed  PubMed Central  Google Scholar 

  99. Allen HD et al (1974) Echocardiographic demonstration of a right ventricular tumor in a neonate. J Pediatr 84(6):854–856

    Article  CAS  PubMed  Google Scholar 

  100. Shaher RM et al (1972) Clinical presentation of rhabdomyoma of the heart in infancy and childhood. Am J Cardiol 30(1):95–103

    Article  CAS  PubMed  Google Scholar 

  101. Bini RM et al (1983) Investigation and management of primary cardiac tumors in infants and children. J Am Coll Cardiol 2(2):351–357

    Article  CAS  PubMed  Google Scholar 

  102. Deeg KH et al (1990) Prenatal ultrasound diagnosis of multiple cardiac rhabdomyomas. Pediatr Radiol 20(4):291–292

    Article  CAS  PubMed  Google Scholar 

  103. Bhandari AK, Nanda NC, Hicks DG (1982) Two-dimensional echocardiography of intracardiac masses: echo pattern-histopathology correlation. Ultrasound Med Biol 8(6):673–680

    Article  CAS  PubMed  Google Scholar 

  104. Brown IW et al (1990) Left ventricular fibroma: echocardiographic diagnosis and successful surgical excision in three cases. J Cardiovasc Surg (Torino) 31(4):536–540

    CAS  Google Scholar 

  105. Filiatrault M et al (1991) Cardiac fibroma presenting with clinically significant arrhythmias in infancy. Pediatr Cardiol 12(2):118–120

    Article  CAS  PubMed  Google Scholar 

  106. Fernando SS (1979) Cardiac fibroma (fibrous hamartoma) of infancy. Two case reports. Pathology 11(1):111–117

    Article  CAS  PubMed  Google Scholar 

  107. Etches PC, Gribbin B, Gunning AJ (1980) Echocardiographic diagnosis and successful removal of cardiac fibroma in 4-year old child. Br Heart J 43(3):360–362

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  108. Gribaa R et al (2014) Right ventricular myxoma obstructing the right ventricular outflow tract: a case report. J Med Case Rep 8:435

    Article  PubMed  PubMed Central  Google Scholar 

  109. Xu J et al (2015) Left atrial myoxma presenting as headache in the pediatric patient. J Emerg Med 48(2):161–164

    Article  PubMed  Google Scholar 

  110. Haworth SG (2008) The management of pulmonary hypertension in children. Arch Dis Child 93(7):620–625

    Article  CAS  PubMed  Google Scholar 

  111. Ivy, D. 2013 Chapter 67: Clinical Management of Pediatric Pulmonary Arterial Hypertension, in Moss and Adams Heart Disease in Infants, Children, and Adolescents: Including the Fetus and Young Adult, H.D. Allen, et al. (Eds) Lippincott Williams & Wilkins.

  112. Kelley SA, Kossoff EH (2010) Doose syndrome (myoclonic-astatic epilepsy): 40 years of progress. Dev Med Child Neurol 52(11):988–993

    Article  PubMed  Google Scholar 

  113. van Dijk JG et al (2014) The semiology of tilt-induced reflex syncope in relation to electroencephalographic changes. Brain 137(Pt 2):576–585

    Article  PubMed  Google Scholar 

  114. Bergfeldt L (2003) Differential diagnosis of cardiogenic syncope and seizure disorders. Heart 89(3):353–358

    Article  PubMed  PubMed Central  Google Scholar 

  115. van der Lende M et al (2016) Cardiac arrhythmias during or after epileptic seizures. J Neurol Neurosurg Psychiatry 87(1):69–74

    PubMed  Google Scholar 

  116. Benditt DG, van Dijk G, Thijs RD (2015) Ictal asystole: life-threatening vagal storm or a benign seizure self-termination mechanism? Circ Arrhythm Electrophysiol 8(1):11–14

    Article  PubMed  Google Scholar 

  117. Horrocks IA et al (2005) Anoxic-epileptic seizures: observational study of epileptic seizures induced by syncopes. Arch Dis Child 90(12):1283–1287

    CAS  PubMed  PubMed Central  Google Scholar 

  118. Reeves AL et al (1996) The ictal bradycardia syndrome. Epilepsia 37(10):983–987

    Article  CAS  PubMed  Google Scholar 

  119. Velagapudi P et al (2012) Cardiac arrhythmias and sudden unexpected death in epilepsy (SUDEP). Pacing Clin Electrophysiol 35(3):363–370

    Article  PubMed  Google Scholar 

  120. Edlow JA, Caplan LR (2000) Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage. N Engl J Med 342(1):29–36

    Article  CAS  PubMed  Google Scholar 

  121. Mitra S et al (2001) Anesthetic management of a patient with Klippel-Feil syndrome. J Anesth 15(1):53–56

    Article  CAS  PubMed  Google Scholar 

  122. Li CM et al (2016) Epidemiology of dizziness and balance problems in children in the United States: a population-based study. J Pediatr 171:240–247

    Article  PubMed  Google Scholar 

  123. Maski K, Owens J (2018) Pediatric sleep disorders. Continuum (Minneap Minn) 24(1):210–227

    Google Scholar 

  124. Marret S, Jeannot E, Fessard C (1990) Sudden severe hypoxemia: a cause of severe fainting attacks in infants. Pediatrie 45(7–8):467–470

    CAS  PubMed  Google Scholar 

  125. Davidson E et al (1989) Drug-related syncope. Clin Cardiol 12(10):577–580

    Article  CAS  PubMed  Google Scholar 

  126. Hussain T, Greenhalgh K, McLeod KA (2009) Hypoglycaemic syncope in children secondary to beta-blockers. Arch Dis Child 94(12):968–969

    Article  CAS  PubMed  Google Scholar 

  127. Fanoe S et al (2007) Syncope and QT prolongation among patients treated with methadone for heroin dependence in the city of copenhagen. Heart 93(9):1051–1055

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  128. Narkiewicz K, Cooley RL, Somers VK (2000) Alcohol potentiates orthostatic hypotension : implications for alcohol-related syncope. Circulation 101(4):398–402

    Article  CAS  PubMed  Google Scholar 

  129. Michaud L et al (1997) Gastroesophageal reflux and esophageal motility disorders in infants with vagal hyperreflectivity presenting severe syncope. Arch Pediatr 4(2):133–139

    Article  CAS  PubMed  Google Scholar 

  130. Tieder JS et al (2016) Brief resolved unexplained events (formerly apparent life-threatening events) and evaluation of lower-risk infants. Pediatrics 137(5):e20160591

    Article  PubMed  Google Scholar 

  131. Colman N et al (2009) Value of history-taking in syncope patients: in whom to suspect long QT syndrome? Europace 11(7):937–943

    Article  PubMed  Google Scholar 

  132. MacCormick JM et al (2011) Symptoms and signs associated with syncope in young people with primary cardiac arrhythmias. Heart Lung Circ 20(9):593–598

    Article  PubMed  Google Scholar 

  133. Marks ML et al (1995) A new form of long QT syndrome associated with syndactyly. J Am Coll Cardiol 25(1):59–64

    Article  CAS  PubMed  Google Scholar 

  134. Ritter S et al (2000) What is the yield of screening echocardiography in pediatric syncope? Pediatrics 105(5):E58

    Article  CAS  PubMed  Google Scholar 

  135. Sachdeva R, Samai C, Vincent RN (2015) Pediatric appropriate use criteria for echocardiography: implications for clinical practice. Pediatrics 135(5):e1128–e1130

    Article  PubMed  Google Scholar 

  136. Brignole M et al (2006) A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals. Eur Heart J 27(1):76–82

    Article  PubMed  Google Scholar 

  137. Moss AJ et al (2000) Effectiveness and limitations of beta-blocker therapy in congenital long-QT syndrome. Circulation 101(6):616–623

    Article  CAS  PubMed  Google Scholar 

  138. Chlebowski M, O’Brien J, Hertzenberg C, Wagner JB (2016) Asymptomatic left ventricular myxoma in a 12-year-old male. Tex Heart Inst J 43(3):267–269

    Article  PubMed  PubMed Central  Google Scholar 

  139. Cannon B, Wackel P (2016) Syncope. Pediatr Rev 37(4):159–167

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Sandra Sexson MD, Kevin Garner R Ph, Ann Pollard, Vivian Thorne, and the members of American Academy of Pediatrics Section on Cardiology and Cardiac Surgery Publications and Communications Committee.

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Cincinnati and Cincinnati Children’s Hospital, Cincinnati, OH, USA

    Juan Villafane

  2. Department of Surgery, Division of Cardiothoracic Surgery, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO, USA

    Jacob R. Miller & Pirooz Eghtesady

  3. Department of Pediatrics, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, USA

    Julie Glickstein

  4. Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA

    Jonathan N. Johnson

  5. Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA

    Jonathan Wagner

  6. Congenital Heart Collaborative, Rainbow Babies and Children’s Hospital, Case Western University, Cleveland, OH, USA

    Chris S. Snyder

  7. Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Tatiana Filina & Scott L. Pomeroy

  8. Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA

    S. Kristen Sexson-Tejtel

  9. Department of Pediatrics, Children’s Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO, USA

    Caitlin Haxel

  10. Lancaster Pediatric Associates, Lancaster, PA, USA

    Jason Gottlieb

  11. Cardiology Care for Children, Lancaster, PA, USA

    Devyani Chowdhury

  12. Department of Pediatrics, 743 East Broadway, Suite 300, Louisville, KY, 40202, USA

    Juan Villafane

Authors
  1. Juan Villafane
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jacob R. Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julie Glickstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jonathan N. Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jonathan Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chris S. Snyder
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tatiana Filina
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Scott L. Pomeroy
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. S. Kristen Sexson-Tejtel
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Caitlin Haxel
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jason Gottlieb
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Pirooz Eghtesady
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Devyani Chowdhury
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JV, as the first author, conceptualized the manuscript and performed the literature search for the overall manuscript. He assigned the appropriate sections to the co-authors and formatted the manuscript. He was aided in writing the entire manuscript as well as editing, final review, and approval of the manuscript. JM participated in writing-specific sections and editing the entire manuscript. He coordinated and oversaw all of the editing and references and eligibility for the manuscript. JG assisted in writing-specific sections of the manuscript. She edited and reviewed the entire manuscript. She helped formulate the tables and figures. Jonathan Johnson participated in writing-specific portions of the manuscript and was involved in the review process. Jonathan Wagner was the primary author of specific sections of the manuscript and helped in editing the entire document. CS served as the author of specific sections and aided in the editing of the manuscript and tailoring it to the anticipated readers. TF and SP served as co-authors for the neurological sections of the manuscript and helped with designing some of the figures and tables. S. Kristen Sexson-Tejtel and CH served as the primary author of specific sections of the manuscript. JG, a pediatrician, formatted tables for the manuscript and edited the entire manuscript to align with the pediatrician’s concerns on the topic. PE served as mentor for the portions of the manuscript relating to surgical indications and procedures. DC, senior author, helped to conceptualize and design the manuscript, handled multiple logistical tasks, participated in writing and editing the entire manuscript, and aided in providing the final decision for all controversial issues. She also provided feedback and helped to develop the tables. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Juan Villafane.

Ethics declarations

Conflict of interest

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Villafane, J., Miller, J.R., Glickstein, J. et al. Loss of Consciousness in the Young Child. Pediatr Cardiol 42, 234–254 (2021). https://doi.org/10.1007/s00246-020-02498-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-020-02498-6

Keywords

Search

Navigation