The school environment can be full of syncope triggers - crowded spaces, prolonged periods of standing (many a school nurse has been called to a choir room!), emotional stressors, and high levels of anxiety. Additionally, fainting in kids can also be caused by underlying health conditions. All to say, fainting and dizziness are not uncommon among school-age children. According to the American Academy of Pediatrics (AAP), "As many as 1 in 4 healthy children and adolescents have fainted at some point." Another study published in the Journal of Pediatrics found that "more than 1 in 20 (nearly 3.3 million) children between the ages of 3 and 17 have a dizziness or balance problem," with 35.1% reporting lightheadedness as their primary complaint.
Understanding Fainting (Syncope) in Students
Syncope is a medical phenomenon that causes temporary loss of consciousness due to a sudden drop in blood pressure, resulting in decreased blood flow to the brain. Although syncope can be a concerning experience, it is generally a benign condition that does not pose a significant risk to one's overall health. Several non-life threatening factors, as mentioned above, including dehydration (the number one cause of fainting in children), stress, fatigue, or prolonged standing, may contribute to the occurrence of syncope.
Neurally mediated syncope is the most prevalent type of fainting and is most common in children and young adults. This type of syncope is distinguished by peripheral vasodilation, which results in a decrease in blood pressure accompanied by bradycardia and is often referred to as reflex, neurocardiogenic, vasovagal, or vasodepressor syncope.
Cardiac syncope is defined as fainting "caused by bradycardia, tachycardia, hypotension due to low cardiac index, blood flow obstruction, vasodilation, or acute vascular dissection." While rare, the increased possibility of cardiac syncope in children comprises fainting while exercising, palpitations beforehand, and fainting without any warning signs.
Postural orthostatic tachycardia syndrome (POTS) affects up to 1 in every 100 adolescents (up to 75% female). It is characterized by extreme tachycardia when moving from lying to standing and other symptoms, including palpitations, dizziness, lightheadedness, near fainting, and fatigue. The onset of POTS is often linked to acute viral illnesses, and other triggers may include injury (concussion), surgery, puberty, or growth spurts.
Addressing Dizziness in Students
Dizziness can include feelings of lightheadedness, disorientation, spinning, or fuzziness in the head and is classified into four categories: vertigo, presyncope, disequilibrium, and nonspecific or atypical dizziness. Determining appropriate interventions requires careful assessment by the school nurse. A student experiencing presyncope dizziness may complain of being light-headed, while dizziness caused by disequilibrium results in feeling off balance. Vertigo is the sensation or perception that the room is spinning or tilting. Common causes of vertigo in children include ear infections and migraine headaches.
Managing Fainting & Dizziness in Students
To properly manage episodes of fainting and dizziness, here are a few things school nurses should remember:
- Ensure Safety: After an episode of fainting, ensure the student is lying flat with legs elevated higher than the heart to improve blood flow. Check the student's vital signs and responsiveness. Remove any hazardous objects that might harm the student if another syncope episode occurs.
- Rehydration & Rest: If a child experiences fainting or dizziness due to dehydration, provide fluid replacement, as appropriate. Encourage rest in a quiet, relaxed environment.
- Assessment & Documentation: Carefully assess and document the fainting incident, including precipitating factors, and share pertinent information with the student's parents and/or HCP.
- Referral: If the syncopal episode is linked to physical exertion or assessment reveals concerning symptoms including (but not limited to) tachycardia, chest pain, signs of seizure, or if the student fainted following a head or abdominal injury, immediate medical attention is required. Referral for follow-up evaluation should also occur if it is the student's first fainting episode, if the student is younger than ten, or if there is recurrent fainting or other signs of illness.
- Prevention Education: In teens, 98% of syncopal episodes are due to simple fainting (orthostatic, dehydration, etc.). Provide education on the importance of regular meals, adequate hydration, sufficient sleep, and recognition of early warning signs for fainting.
