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Reflex syncope in children and adolescents
  1. Wouter Wieling1,
  2. Karin S Ganzeboom1,
  3. J Philip Saul2
  1. 1Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to:
    Professor Wouter Wieling
    Academic Medical Center, University of Amsterdam, PO Box 22700, 1100DE Amsterdam, The Netherlands;

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This article will address the epidemiology of reflex syncope in children and adolescents, its clinical characteristics and syndromes, the approach to diagnosis, and finally treatment.


Syncope can be defined as a temporary loss of consciousness and postural tone secondary to a lack of adequate cerebral blood perfusion. The incidence of syncope coming to medical attention appears to be clearly increased in two age groups—that is, in the young and in the old (fig 1).1 An incidence peak occurs around the age of 15 years, with females having more than twice the incidence of males.1,2 Syncope is an infrequent occurrence in adults. The incidence of syncope progressively increases over the age of about 40 years to become high in the older age groups. A lower peak occurs in older infants and toddlers, most commonly referred to as “breath-holding spells”.3

Figure 1

 Frequency of the complaint of fainting as a reason for visiting a general practitioner in the Netherlands. Data are obtained from the general practitioners transition project. It concerns an analysis of 93 297 patient years. The arrow around 1 year is to indicate that a small peak occurs between 6–18 months (breath-holding spells). Between 2–5 years syncope is rare. Revised after Wieling W, et al. Ned Tijdschr Geneesk 2003;147:849–54 with permission of the editor.

The incidence of syncope in young subjects coming to medical attention varies from approximately 0.5 to 3 cases per 1000 (0.05–0.3%).2 Syncopal events which do not reach medical attention occur much more frequently. In fact, the recently published results of a survey of students averaging 20 years of age demonstrated that about 20% of males and 50% of females report to have experienced at least one syncopal episode.4 By comparison, the prevalence of seizures in a similar age group …

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