1 in 4
people may have a syncopal episode before age 25
When kids feel dizzy or faint
Fainting, dizziness, and lightheadedness are common in children and teens, especially during busy school and sports routines. Most episodes are not emergencies, but parents should know what details to watch for and when to ask a pediatric provider for guidance.
When should parents be concerned about fainting, dizziness, or lightheadedness in children and teens?
Parents should seek medical guidance if a child:
- Faints during exercise or sports
- Has chest pain or a racing heart
- Has repeated fainting or dizziness episodes
- Takes longer than expected to recover
- Has a significant head injury
- Has other unusual or concerning symptoms
Even if an episode seems mild, letting your child’s pediatrician know can help determine whether the symptoms sound typical or need closer evaluation.
A child who is about to faint may feel dizzy, lightheaded, warm, clammy, or notice their vision beginning to darken. These symptoms occur when blood pressure drops and, for a brief period, less blood reaches the brain.
“If patients have symptoms but remain conscious, we call that pre-syncope. If they briefly lose consciousness, that is called syncope,” says Hope Breitbach, ARNP, nurse practitioner at UI Health Care Stead Family Children’s Hospital. She notes that symptoms do not always progress to fainting.
Children and teens may feel dizzy, lightheaded, or faint for many reasons.
Common triggers include:
- Not drinking enough fluids
- Not getting enough sleep
- Physical activity or overexertion
- Stress
- Overheating
- Sitting or standing in one position for a long time
“Dehydration, overexertion, overheating, and sedentary lifestyles are the most common ones I see,” Breitbach says.
"The vast majority of episodes of syncope are not dangerous or emergent. They’re scary to watch, but there is nothing dangerous happening."
Hope Breitbach, ARNP
Benjamin Hale, MD, MS, CEPS-P, CCDS, a pediatric cardiologist at Stead Family Children’s Hospital says some children are also more prone to fainting because of how their nervous system responds to certain triggers
Fainting can be frightening for parents, caregivers, coaches, and school staff to watch. But Breitbach says it is also common — more than 1 in 4 people may have a syncopal episode before age 25.
“The vast majority of episodes of syncope are not dangerous or emergent,” she says. “They’re scary to watch, but there is nothing dangerous happening.”
Why back-to-school routines can trigger dizziness
Back-to-school routines can make dizziness or fainting more likely. Students may be waking up earlier, sleeping less, returning to sports, sitting through longer class blocks, skipping meals, or exercising before school.
“A lot of high schoolers also do early workouts before school, so if they don’t eat or drink enough, they can have episodes either during the workout or the day of the recovery period,” Breitbach says.
She says longer class periods — as many schools are shifting to block systems — can also contribute.
"They are sitting in their class for an hour and a half instead of 45 minutes,” she says. “I’ve seen a lot more kids have issues with dizziness because they have to sit for so long.”
Patterns can help providers understand what is happening. If a child tends to feel faint after standing for a long time, skipping breakfast, exercising without enough fluids, being overheated, or sitting for a long period, those details can help guide next steps.
“If we can find a clear trigger, that’s really helpful to us,” Hale says.
For many children and teens, lifestyle changes can help reduce dizziness, lightheadedness, or fainting episodes.
“Conservative management, increasing fluid, salt intake, better sleep, regular exercise are great steps,” he says. “It gets the ball rolling by the time we see them.”
Breitbach says hydration is especially important.
“If you drink enough water, a lot of these symptoms may go away,” she says.
What to do and what to remember after a child faints
If a child faints, the first step is to help them stay safe, calm, and lying down. Do not rush them back to standing or walking.
“Sometimes lifting up the legs can help but just keep them kind of safe and calm and lying down,” Hale said.
Breitbach says adults should avoid moving a child too quickly after they begin to wake up.
“Making sure that you’re in no rush to get them upright is one of the most important things,” she says, “They need to regain themselves, or they can pass out again.”
The most common type of fainting in children is vasovagal syncope. It happens when the body overreacts to a trigger — such as standing for a long time, heat, dehydration, pain, fear, or emotional stress — causing a sudden drop in heart rate and blood pressure. A typical vasovagal fainting episode is often very short.
“A vasovagal or fainting syncopal episode is going to be something that resolves pretty promptly within a matter of seconds,” Hale says, adding that around 10 to 15 seconds is typical.
10 to 15 seconds
typical fainting syncopal episode length
If it lasts longer, Hale says that can raise concern.
Then you have to start wondering if there’s something else at play,” he said.
After a child faints or nearly faints, the details matter. Parents, caregivers, school nurses, teachers, or coaches should try to remember what happened before, during, and after the episode. Hale says the story of what happened is often the most important part of the evaluation.
“Most of the time when we see a child who’s passed out for some reason or another, we can make the diagnosis just by hearing the history,” Hale says. “It is by far and away the most important way that we figure out what’s going on.”
When speaking with a pediatrician about their child’s fainting, parents should try to note:
- What the child was doing before symptoms started
- Whether the child was standing, sitting, exercising, overheated, or dehydrated
- Whether the child had eaten or had enough fluids
- Whether the child felt dizzy, lightheaded, hot, flushed, clammy, or had vision changes prior to the fainting episode
- Whether the child had chest pain or a racing heart prior to fainting
- Whether the episode happened during activity or after activity
- How long the child was unconscious
- How the child acted after waking up
- Whether there was shaking, tongue biting, loss of bowel or bladder control, or injury
- Whether the child has had repeated or clustered episodes
How pediatric providers evaluate fainting and dizziness
When a child or teen has fainting, recurring dizziness, or concerning symptoms, a pediatrician or primary care provider is the best first step.
Breitbach says primary care providers can help determine whether the episode sounds like syncope, seizure, or something else.
“Primary care providers will know whether the story sounds concerning for a seizure or is more consistent with syncope," she says. “They can get them pointed in the right direction.”
If a child is referred to pediatric cardiology, the evaluation often starts with the story of what happened.
- A pediatric cardiology evaluation may include:
- A detailed history of the episode
- A review of symptoms before and after fainting
- Family history
- A physical exam
- An electrocardiogram, or EKG
- Orthostatic vital signs, when autonomic dysfunction or POTS are concerns
- Additional testing, such as an echocardiogram or treadmill test, when needed
“We’ll do a physical exam and make sure there’s no obvious problems with the heart sounds,” Hale says. “Everybody who comes into clinic for syncope will get an EKG.”
He says not every child needs advanced testing.
“We don’t always do more advanced testing, and I don’t think patients should expect that,” Hale says.
For some children, especially those with autonomic dysfunction or concern for POTS, Breitbach says orthostatic vital signs may be part of the visit.
“They also get orthostatic vital signs, which is a 10-minute standing test that they do every time they come and see me,” Breitbach says.
While fainting can be common, details matter and pediatric providers can help decide whether further evaluation is needed.
“It’s scary to watch, but not always life-threatening or emergent,” Breitbach says. “Letting your pediatrician know when it happens is helpful.”
Concerned about fainting or dizziness?
If your child has recurring dizziness, fainting during activity, chest pain, a racing heart, or symptoms that worry you, a pediatric provider can help determine the next step.
When fainting or dizziness needs urgent attention
Most fainting episodes are not dangerous, but certain patterns should be taken seriously.
Breitbach says emergency care may be needed if a child faints during activity, such as while running or playing basketball.
“If they’re in the middle of a run, and they fall down, or a basketball court running back and forth and they have an episode then that is more concerning,” she says. “Seeking emergency department-type treatment would be beneficial.”
A significant head injury after fainting is another reason to seek emergency care.
Parents should seek urgent or emergency attention if a child has:
- Fainting during exercise or sports
- Chest pain before or during the episode
- A racing heart before fainting
- Loss of bowel or bladder control
- Tongue biting
- A significant head injury
- Vomiting after hitting their head
- A cut that may need stitches or staples
- A long period of unconsciousness
- Repeated or clustered episodes
- An abnormal heart exam or murmur noted by a provider
- A family history of sudden or unexplained death, unexpected drowning, or unexplained single-car accidents
Hale says certain symptoms catch his attention.
“Loss of bowel or bladder function is important,” he says. “And, if it’s syncope with exertion like you were running and went down all of a sudden, that’s a very important one.”
Why symptoms during sports should not be ignored
ainting, dizziness, chest discomfort, or a racing heart during sports or physical activity should not be ignored. While many fainting episodes are common and not dangerous, exertion can be associated with more concerning heart-related causes.
“Syncope with activity is thought of as a red flag,” Hale says.
He says exertion can be a trigger for certain rhythm conditions.
This matters for student athletes, who may feel pressure to play through symptoms during practice, conditioning, games, or competitions.
“They’re in an environment where there’s a lot of incentive for them to push through,” Hale says.
But reporting symptoms early can help protect the child and may prevent a longer setback.
“You could also be out longer if you don’t take care of it when it first starts,” Breitbach says. “You’re more beneficial to your team and to yourself if you get it taken care of quickly.”
For athletes worried that they will be told they need to take a break from their sport, Hale says pediatric cardiologists take sports restrictions seriously and do not make those decisions lightly.
“We only do it when it’s appropriate,” he says.
"Syncope with activity is thought of as a red flag."
Benjamin Hale, MD, MS, CEPS-P, CCDS
What parents can do next
Most fainting and dizziness in children and teens is not dangerous, but parents do not have to determine the cause on their own. Keep track of what happened, encourage healthy hydration and routines, and tell your child’s pediatrician. It is especially important to reach out to your child’s provider if symptoms recur, happen during activity, or come with other concerning signs.
Talk with a pediatric provider
If your child has fainted, feels lightheaded often, or has symptoms during sports or activity, schedule an appointment with your PCP to discuss what happened and whether further evaluation is needed.