Morning Fainting in Toddlers: Causes and Concerns

A two-year-old child fainting upon waking up in the morning?

Hello Dr.
Lin: I have a three-year-old boy at home who experiences fainting spells or appears to have a blank stare with his eyes rolled back for about 20 to 30 minutes every morning after waking up.
He also exhibits leg twitching during these episodes.
This condition has persisted for about a month, occurring once daily at the same time.
Both a CT scan of the brain and an electrocardiogram have returned normal results, and we are scheduled for an MRI next.
I would like to ask Dr.
Lin: 1.
Is it possible that this could be a symptom of epilepsy? 2.
Since we have not been able to identify the cause, should we refer him to another specialty for further evaluation? 3.
Could this be related to delayed brain development? He has not yet started speaking, but his general cognitive responses seem normal.

David, 0~9 year old female. Ask Date: 2009/09/06

Dr. Lin Zijing reply Neurology

Fainting accompanied by transient loss of consciousness, blank stare, eye rolling, and leg twitching should raise suspicion for either epilepsy or transient cerebral hypoperfusion.
Generally, brain and cardiac evaluations are necessary.
Brain assessments include electroencephalography (EEG) and magnetic resonance imaging (MRI), while cardiac evaluations involve 24-hour Holter monitoring and echocardiography.
It is advisable to conduct the EEG during episodes of frequent fainting to better capture any abnormal discharges.
If developmental delays are suspected, a referral to a pediatric neurodevelopmental specialist for evaluation should be made after confirming no issues with the MRI and EEG.

Reply Date: 2009/09/06

More Info

Dear Inquirer,
Thank you for reaching out with your concerns regarding your three-year-old son’s episodes of fainting or altered consciousness in the mornings. This situation can understandably be alarming for any parent, and it’s important to approach it with careful consideration of the potential causes and necessary evaluations.

1. Possibility of Epilepsy: The symptoms you describe—fainting, eye rolling, and leg twitching—could potentially be indicative of seizures, including those associated with epilepsy. While the normal results from a CT scan and ECG are reassuring, they do not completely rule out the possibility of seizure disorders. Epileptic seizures can sometimes be subtle and may not always be detected on initial imaging or electrical activity tests. A thorough evaluation by a pediatric neurologist is recommended, as they can provide more specialized insight and may suggest further testing, such as an EEG (electroencephalogram), which measures electrical activity in the brain and can help identify seizure activity.

2. Need for Further Evaluation: Given that your son has been experiencing these episodes consistently for about a month, and considering the normal results from previous tests, it may be prudent to seek a referral to a pediatric neurologist if you haven’t already. They can conduct a more comprehensive assessment, including a detailed history of the episodes, any potential triggers, and developmental milestones. If there are concerns about other underlying conditions, such as metabolic disorders or genetic syndromes, the neurologist may recommend additional tests or referrals to other specialists.

3. Developmental Considerations: You mentioned that your son is not yet speaking but has normal cognitive responses. Delayed speech development can sometimes be associated with various developmental disorders, but it is essential to understand that many children develop at their own pace. The episodes of fainting or altered consciousness may or may not be related to his speech delay. A developmental pediatrician could provide valuable insights into his overall development and whether any interventions are necessary.

In summary, while the symptoms your son is experiencing could potentially be related to epilepsy, it is crucial to conduct further evaluations to rule out or confirm this diagnosis. Consulting with a pediatric neurologist will be an important step in understanding the nature of these episodes and determining the best course of action. Additionally, addressing any developmental concerns with a specialist can provide a more holistic view of your son's health and development.

It is essential to keep a detailed log of your son's episodes, including their duration, frequency, and any accompanying behaviors or triggers, as this information can be invaluable for healthcare providers in making an accurate diagnosis.
I hope this information helps guide you in seeking the appropriate care for your son. Please ensure to follow up with your healthcare provider for any immediate concerns or changes in his condition.

Best wishes for your son's health and well-being.

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