Managing Pediatric Syncope in Primary Healthcare Settings

K Suresh*

Temporary Loss of Consciousness (TLOC) commonly known as Fainting or Syncope is a heterogeneous syndrome with complex underlying mechanisms, with a broad spectrum of presentation, even in pediatric clinics in Developing countries including India. The objective of this article is to emphasize the importance of early diagnosis and structured follow-up in resource limited setting for the primary health care providers. It is a common clinical complaint that a pediatrician or general practitioner in Rural India encounters in the outpatient clinic or as an emergency case. The cause-based classification of syncope include i) Autonomic syncope is the commonest which is usually benign ii) Cardiovascular syncope can potentially be life threatening, therefore, it is important to recognize and refer such cases to a specialist in a timely manner iii) Neurological Syncope -is possible to identify the in most patients with a detailed history & physical examination.

In India the diagnosis of TLOC begins with history taking, its interpretation, & investigations to rule out diseases like Seizures that require differentiation from syncope. Training clinicians to interpret patient history effectively during clinical postings during students and Internship life and later practicing them in the routine practice are the main facilitators that can bridge the diagnostic gap between experts and nonexperts. The most frequent source of error is a clinician’s misconception rather than an inaccurate account of patient symptoms. Some clinicians have several diagnostic pitfalls while evaluating patient’s history, which is guided by his/her understanding of the pathophysiology and clinical clues. Another challenge is patients’ use of colloquial terms by the patients/parents which confuse an urban grown clinician, in earlier few weeks or months of each regional posting/working of exposure to local dialect, which leads to poor communication between doctors and patients. 

Electrocardiogram (ECG) is the only investigation possible in primary health care settings, though 2D Echocardiogram and Electroencephalogram are important tools for the early diagnosis and treatment of cardiac and neurological etiology of syncope.

Materials and methods: This article is an outcome of seeing hundreds of Pediatric Syncope cases, managing or referring and following the referred cases on their return and monitoring the prognosis over the last decade, and quoting anecdotal cases supported by literature research about the varied presentations, diagnostic procedure and management practices both by general practitioners and specialist as per the cause of the Syncope.

Keywords:

Published on: Apr 22, 2025 Pages: 1-6

Full Text PDF Full Text HTML DOI: 10.17352/ojpch.000059
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