Pedemy All toolsTap the history and exam findings. Most fainting and chest pain in children is benign; the red flags pick out the few with a cardiac cause who need cardiology — and no sports — before they are cleared.
This tool helps clinicians sort fainting and chest pain in children and teens into likely benign causes and the small group who may have heart disease. Choose syncope or chest pain, tap the history red flags, then the exam and ECG findings. The result says whether to send the patient to the emergency department now, refer urgently to pediatric cardiology with no sports in the meantime, or treat as vasovagal syncope or a non-cardiac chest pain cause, with what to tell the family and when to return.
For syncope it follows the 2017 ACC/AHA/HRS guideline, which recommends a detailed history, examination, family history and a 12-lead ECG in every child who faints. Features that raise concern for a cardiac cause include fainting during exercise, no warning, palpitations just before, loud-noise or emotional triggers, a family history of sudden death under 50 or inherited heart disease, an abnormal exam and an abnormal ECG such as long QT, pre-excitation, Brugada pattern, hypertrophy or heart block. The AAP 2021 statement advises holding these children from sports until cardiology evaluation is complete.
For chest pain it uses the red flags from the standardized SCAMP approach and recent reviews: pain with exertion, syncope or palpitations, fever, family history, Kawasaki or other heart disease, stimulant use, Marfan features, clot risk and sickle cell disease. Only about 1% of children seen in cardiology for chest pain have a cardiac cause. Without red flags, the tool lists the common causes, such as costochondritis, precordial catch, asthma, reflux and anxiety, with simple management. It also shows orthostatic vital sign cutoffs and the AAP four-question screen.
Yes. The 2017 ACC/AHA/HRS guideline gives a Class I recommendation for a detailed history, physical examination, family history and a 12-lead ECG in all pediatric patients presenting with syncope, even when the story sounds vasovagal. Look for long QT, pre-excitation, Brugada pattern, hypertrophy, heart block and epsilon waves.
Fainting during exercise, fainting with no warning or while lying down, palpitations or chest pain just before, fainting triggered by a loud noise, startle or swimming, and a family history of sudden unexplained death before 50 or inherited heart disease. These children should stop sports until a pediatric cardiologist has evaluated them.
Reassure the family that it is benign, teach the warning signs and triggers, lie down at the first symptoms, and use counter-pressure maneuvers such as leg crossing with muscle tensing or squatting. More fluid and salt may help some patients. Midodrine is reasonable for refractory cases; beta blockers are not beneficial in children.
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