Investigating syncope in children and adolescents

Syncope, or fainting, is a heterogeneous condition and hence difficult to diagnose. Treatments for syncope are vast and largely ineffective because individual variability impacts success. Research into the mechanisms and treatment of syncope has focused on adults, despite 15-25% of children experiencing episodes. Thus, we aimed to investigate syncope in children and adolescents and explore a non-pharmacological approach to its treatment. We conducted cardiovascular autonomic function testing (Valsalva manoeuvre, cerebral reactivity to hypo- and hypercapnia, and orthostatic stress testing) to evaluate cardiovascular factors predisposing to syncope in 21 children. We also evaluated the efficacy of graded calf compression stockings for the treatment of syncope in 15 young adults. We found that (1) autonomic function testing in children was appropriate, but current diagnostic criteria may need to be altered for paediatric populations; and (2) the utility of calf compression stockings to improve orthostatic tolerance is dependent on specific anthropometric variables.