My Child Fainted! What Do We Do Now?

Q&A with Dr. Brandon Harden, Pediatric Cardiologist & member of the Children’s Cardiology Syncope team

Fainting or chronic dizziness in children and adolescents is often a sign that something’s not quite right, and if it happens frequently, they will be referred to a pediatric cardiologist to rule out certain heart conditions. When those are ruled out, the diagnosis is often dysautonomia.

According to Children’s pediatric cardiologist Brandon Harden, MD, dysautonomia is relatively common, with more than 70 million people worldwide living with various forms of it. Dysautonomia is an umbrella term used to describe a malfunction of the autonomic nervous system that controls the automatic functions of the body like heart rate, blood pressure and temperature control.

Pediatric patients may be told they have vasovagal syncope, neurocardiogenic syncope, orthostatic intolerance or postural orthostatic tachycardia syndrome (POTS), which are all types of dysautonomia.

Q: Why does dysautonomia happen in children and adolescents?

A: Dysautonomia can happen for several reasons, or it can be idiopathic, which means the cause is unknown. Other times dysautonomia can occur include:

Following a growth spurt or first period
Post-infection, such as mononucleosis or COVID
Post-concussion
Post-immunization
Following a significant physical or psychological trauma

Q: What happens to the body when we get dizzy or faint?

A: When we stand, gravity pulls about 25% of the blood in our body to our feet. The heart is now about 25% underfilled, as is the brain, and blood pressure briefly drops. When everything is working properly, sensors in the body detect a change, tell the brain about it and the brain signals the body what to do to make things normal. The body responds within fractions of a second by increasing the heart rate, adjusting how hard the heart pumps and tightening the blood vessels. But if the body doesn’t recognize the problem and address it quickly enough (which can be made worse by being dehydrated or anemic), blood pressure drops more, and the brain sends out a surge of adrenaline to get things back on track.

Adrenaline helps the blood to move upward to the heart and the brain better by tightening the blood vessels and speeding up the heart rate. This response is designed to keep people from fainting or help them respond to a threatening situation. However, if a kid is dizzy many times a day and experiences repeated adrenaline surges, it’s like riding a roller coaster repeatedly. The body will eventually suffer negative effects from the surges.

Q: How can repeated adrenaline surges affect the body?

A: Some effects of repeated adrenaline surges include:

Fatigue
Insomnia
Waking up a lot at night
Sleeping a lot and not feeling rested
Muscle pain
Brain fog – problems remembering, concentrating, focusing
Anxiety, moodiness
Lack of motivation
Nausea
Poor appetite
Feeling full early
Constipation, diarrhea (less often), or constipation alternating with diarrhea
Abdominal pain
Fast heart rate
Pounding heartbeat
Chest tightness
Shortness of breath
Feeling overly hot
Sweating
Feeling jittery or shaky
Skin sensitivity/pain
Purple, red, or white discoloration of the skin, or mottling of the skin tone
Variable blood pressures
Dilated pupils

Q: What can my child do when they feel dizzy?

A: Dizziness is an indication that the body will soon produce an adrenaline surge to improve how blood gets to the brain. Our goal is to improve the brain’s blood supply to reduce and eventually eliminate the dizziness and the accompanying adrenaline surges. We do this by introducing extra fluids, extra salt, muscle squeezing exercises and compression garments.

If those interventions don’t help, physicians can consider prescribing medication that will raise the blood pressure or lower the heart rate.

Q: What are the signs that the brain is not getting enough blood flow?

Dizziness and/or fainting
Heart racing
Heart pounding
Head pounding
Vision changing (blurry, dim, black, spots, tunnel vision)
Hearing changing (muffled, hearing nothing, hearing your heartbeat)
Wave of nausea
Hot flashes
Inappropriate sweating

Q: What should my child do if they notice these signs?

DO NOT TRY TO PUSH THROUGH!
Sit or lie down
Do muscle squeezing exercises
Drink water
Eat a salty snack, take extra salt tablets or drink an electrolyte drink
Cool down if overheated (get to a shaded area or air-conditioning, use a cooling scarf, shirt, or vest, or drink cold or cool water)

Your child’s provider can give you in-depth information about how to treat dysautonomia.

Adolescence, when half of patients with POTS are diagnosed, is an important time in which many changes occur in the body. There are many common-sense approaches to treating dysautonomia, and patients do best when they take responsibility for recognizing and addressing the dizziness triggers in their own bodies. Getting adequate rest and hydration goes a long way in improving the quality of life, and we typically see symptoms fade as the child gets older.

Syncope Team: