Syncope in childhood is a common problem. In most children, syncope is beni
gn, secondary to a disturbance in autonomic control of heart rate and blood
pressure. It is increasingly evident that neurally mediated syncope is a h
eterogeneous group of conditions, necessitating a reclassification of auton
omic disorders. New entities, such as postural orthostatic tachycardia and
cerebral vasoconstrictive syncope, are recognized. The key to the diagnosis
of syncope is a careful history. Tilt testing can be useful when the histo
ry is unclear. Unfortunately tilt test protocols vary, affecting specificit
y and sensitivity. The mainstay of therapy is reassurance. if symptoms are
troublesome, Fludrocortisone and B-blockers remain the favored drugs. The e
fficacy of Midodrine and Serotonin Uptake Inhibitors is currently under rev
iew. Cardiac pacing is effective for those patients with severe episodes an
d demonstrated asystole. It is not known whether pacing would be effective
for the majority who have neurally mediated syncope without significant bra
dycardia. Curr Opin Cardiol 2001, 16:92-96 (C) 2001 Lippincott Williams & W
ilkins, Inc.