For Health Care Providers:

Orthostatics – Heart rate and blood pressure while sitting and then after standing for 2 minutes. LIGHTHEADEDNESS Abnormal • Systolic blood pressure falls > 20 mmHg AND FAINTING • Pulse increases > 40 beats per minute

Electrocardiogram (ECG) – Should be obtained if a normal ECG is not available from the previous 90 days.

Abnormal QTc: Should my child see a health care provider for Boys and prepubertal girls > 450 msec lightheadedness or fainting? Adolescent and older girls > 470 msec

Consult with your child’s primary care provider if you Criteria for Cardiology Evaluation/Echocardiogram need additional information. • Abnormal ECG • Abnormal cardiovascular examination What tests should my health care provider • Family history of cardiomyopathy perform when evaluating my child for • Family history of unexplained sudden death lightheadedness or fainting? • History suggestive of acute myocarditis • Syncope during exertion • Suspected Central Nervous System (CNS) disease Unless other risk factors are identified, the only tests routinely recommended are an ECG (electrocardiogram) Criteria for Neurology Evaluation/EEG and measurement of “orthostatic” blood • Clinical diagnosis of seizure disorder pressures (performed when laying down and then standing). Criteria for Brain MRI • Abnormal neurological examination • Suspected CNS disease

Criteria for Laboratory Analysis • Abnormal orthostatic evaluation • Suspected anemia

Information for patients, families and health care providers about this common condition. Lightheadedness and fainting are common How can lightheadedness and fainting be When feeling lightheaded, sit down or lie down. among children and teenagers. prevented? Counter-pressure techniques can also help prevent fainting: What causes lightheadedness and fainting? Have your child: Crossing legs and squeezing the leg muscles until the lightheaded feeling These symptoms usually result from not enough • Drink more water (their urine should be clear) goes away blood getting to the brain. Lightheadedness and • Eat more salt fainting are rarely caused by serious medical • Eat healthy meals often enough to avoid getting problems. too hungry • Avoid caffeine Gripping hands and trying to pull What makes this more likely to occur? • Avoid standing in one position for a long time them apart and down • Stand up slowly after sitting or lying down • Avoid getting too hot from hot tubs or standing • Not drinking enough water too long in a hot shower What risk factors suggest a • Skipping meals • Sit when having their hair brushed or combed • Standing up too fast more serious cause for fainting? by someone else • Standing for too long without moving around • Boys who are prone to fainting should sit on • Having your hair brushed or combed while • Needed CPR after faint the toilet to urinate, especially first thing in the standing • Significant injury resulting from a faint morning • Being too hot – including from hot showers and • Fainting with exercise • Talk with your primary care provider about hot tubs • Faint triggered by fright or sound/noise compression stockings • Breath-holding • No preceding sensation (like lightheadedness) • Low red blood counts (anemia) • Unusual preceding sensation, such as an odd smell What should I do if my child or teen or rising feeling in abdomen becomes lightheaded or faints? • Chest pounding or chest pain/pressure preceding faint The best treatment is to get more blood to your • Posturing, jerking for 1 minute or more with the child’s brain. faint • Abnormal heart or neurologic examination To do this, help your • Abnormal electrocardiogram child lay down and raise • Close family history of unexplained sudden death, his/her legs above the heart rhythm problems or cardiomyopathy, or level of the head. seizures • History of brain or cardiac injury or disease Alternatively, have him or her sit down with his/her • Underlying metabolic or kidney disease head between the knees. • Peripheral or autonomic neuropathy • Significant developmental delay