Background Syncope is a common problem in adolescents, up to 1 in 5 experiencing an episode before the adulthood. Whereas the vast majority of syncope is benign, a minority is caused by something more serious or even life-threatening. It generates extreme anxiety and is often extensively investigated.

Material and Method The study was performed during a 3 years period (Jan 2005–Jan 2008). We retrospectively reviewed the records of 178 children and adolescents seen in our Pediatric Department for fainting.

Results Upon careful review, 30 patients had not had any type of syncopal episode. Of the remaining 148 patients, 48 experienced syncope and 100 near syncope. The most frequent diagnose was the vaso-vagal syncope (50%). Other diagnoses were: orthostatic hypotension (10%), atypical seizure (7.5%), migraine (2%), minor head trauma (5%). The remaining 25% patients were diagnosed with syncope secondary to cardiac diseases. The most important were: hypertrophic cardiomyopathy (4); dilated cardiomyopathy (3); acute mycocarditis (3); complete atrio-ventricular block (2), primary pulmonary hypertention (1).

Conclusions Despite the likelihood of a benign cause, any child who experience syncope would be transported to and receive medical evaluation in a hospital or emergency department, because in some cases, the etiology of the syncope could include life-threatening diseases. Every patient evaluated for the loss of consciousness should receive a baseline ECG. If structural cardiac disease is suspected, an echocardiogram is indicated, because the potential poor outcome is highest if a cardiac etiology is found.