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Neurally Mediated Syncope (NMS) occurs in about 30% of individuals. It is the leading cause of fainting spells in the pediatric age group.

The common fainting spells is usually not serious. It is usually comes with lightheadedness, sweating, sensation of warmth, nausea, visual and auditory changes. It is brief and usually do not have any warning. Teenagers are more affected than younger children. Most of the time they are standing when NMS occurs. In about 5% they might be sitting in the classroom or in a car. NMS is not uncommon after getting a shot (immunization).

Palpitation, of the feeling of the heart beating against the chest wall, does not go with NMS. If there palpitation, arrhythmia (heart beat irregularity) should be suspected. Those who witness the fainting spell usually describe paleness in the teenager.

Sometimes, NMS is accompanied by a brief tonic-clonic (seizure like) movement of the arms and legs. Usually there is no incontinence. If there is incontinence, seizures or convulsion should be suspected. In seizures, the patient usually are sleepy or confused after the spell, however, in NMS there is no changes in behavior or alertness following the faint.

In about 30% of patients with NMS, there is similar family history in the first-degree relatives.

Sometimes ECG (heart tracing), EEG (brain wave test), and head upright tilt study might be needed to figure out the cause of fainting.

Some patients with NMS might need salt tablets, fludrocortisone acetate, or beta blockers. Teenagers should sit or lay down about 20 minutes after getting a shot or immunization because NMS is common at this age group.

Children with fainting spells should be seen by a clinician for evaluation.

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Leo Leonidas, MD, FAAP, Assistant Clinical Professor in Pediatrics, Tufts University School of Medicine, Boston;  Attending Pediatrician, Eastern Maine Medical Center, Bangor, Maine.

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