Faints, dizziness, palpitations and chest pain in children and young people

You have recently come for an appointment where you discussed that your child’s symptoms are not related to their heart. We are aware this doesn’t mean your child’s symptoms have gone away and this information sheet is to help you understand what might be happening and think about some things that might help.

Possible causes of fainting and dizziness

There are many reasons why someone might faint or experience dizziness (light-headedness). For example:

• Standing up too quickly, or standing for long periods of time.
• Not eating or drinking enough.
• Being too hot.
• Being very upset, angry or in pain.
• Hormonal changes.

Many of the above causes lead to a decrease in blood flow to the brain, which can cause faints and dizziness.

• The medical term for this is vasovagal syncope.

How to help your child manage physical symptoms of faints and dizziness

• If possible, lie down – this can help prevent a fainting episode as it allows blood back to the brain. When they are feeling better make sure that they stand up slowly or move to a sitting position for a few minutes before fully standing.
• Have your child sit down with their head lowered between their knees – this will help blood get back to the brain. When they are feeling better, move slowly into an upright position and then stand.
• Hydration – it is important to drink enough fluid throughout the day, have access to filling up a water bottle at school and to drink lots of water before, during and after exercise, especially in hot weather.
• Keep blood circulating – if they have been sat down for a while, ask them to take a break and move around. Children can also do calf exercises to help keep the blood pumping well around the body.
• Avoid overheated, cramped or stuffy environments whenever possible.

Possible causes of palpitations

Your heart rate changes throughout the day depending on what you are doing, for example, it will increase during exercise and when you feel poorly or excited. Children often become aware of their heart beat at primary school age, especially at times where their heart is beating quickly. They often describe this as their heart ‘hurting’, ‘pounding’ or ‘fluttering’.

How to help your child manage physical symptoms of palpitations

Noticing your heart beat can cause people to worry or panic, which can cause the heart to beat faster which can be even more worrying. We know from your child’s cardiac tests that their heart is normal and noticing their heart beat isn’t a sign that something is wrong. If your child is upset or scared when they notice their heart beating, you could try:

• Slowly counting to 10.
• Taking big slow deep breaths.
• Sitting down, closing your eyes and think of something that makes you happy or relaxed.

These should help your child feel calmer and can calm their heart rate.

Possible causes of chest pains

Chest pain in children is very common, and we know from the tests that the pain is not coming from their heart.

• Indigestion or reflux – this pain will often be connected with eating or drinking, it can feel worse when lying flat, and your child may also have sickness or vomiting. Speak to your GP or paediatrician if you think your child may have this.
• Musculoskeletal pains – your chest is made up of many bones (ribs, breastbone), ligaments and breathing (intercostal) muscles. These are all constantly moving with every breath we take. Inflammation or spasm (cramp) of any of these can cause chest pain. This is not dangerous. Reassurance, gentle stretching and sometimes painkillers is usually all that is required to manage it.

Healthy lifestyle and self-care

For all these symptoms a healthy lifestyle both mentally and physically is very important. You could try:

• Regular meals and plenty of water each day.
• Eat healthy and have a balanced diet.
• Regular physical exercise – aim for 3-4 times a week.
• Learn breathing techniques.
• Good sleep routine.

Psychological coping of faints, dizziness, palpitations and chest pain

It is reassuring to hear from your doctor that your child’s heart is normal, but it is understandably worrying to not know the reason why your child is having these symptoms.
When your child has an episode of these symptoms you both may feel panic and may spend time after worrying about if or when the symptoms will happen again.
Thinking about symptoms can make you notice them more or mean that you are always looking out for them or waiting for them to happen.

How worry can physically affect us

It is very common to feel dizzy, faint, short of breath or have chest pain when we are feeling worried. People feel worry in different places and might experience some or all of the below:

• Sweating
• Clammy hands, feeling hot, sticky & uncomfortable
• Jelly legs, fidgety, shaky, aches & pains in body
• Muscle tension
• Butterflies, knots in stomach, cramps, indigestion, nausea and diarrhoea
• Faster & heavier breathing
• Faster heartbeat and increased blood pressure
• Heart pounding, hot flushes, dizziness and tingling in arms or legs
• Slowed digestion of food
• Shortness of breath, gasping for breath, difficulty swallowing,
• Feeling like you can’t breathe or a choking feeling

How anxiety and worry can affect how we think

• Try to stay calm – it is a normal reaction to worry and panic when your child is experiencing these types of symptoms, however children learn from watching their parent’s reactions and behaviours.
• Try mindfulness techniques – Mindfulness can help relieve stress, regulate our emotions and focus our attention. We have included some mindfulness techniques below for you and your child to try at the end of this leaflet.
• Try breathing techniques – calm breathing can help us to slow down our breathing when we are feeling worried and gives us back a sense of control. We have included some calm breathing techniques at the end of this leaflet for you and your child to try.
• Try distraction techniques – distraction techniques are helpful to use when we need to shift our focus on something else. They can be used if you or your child are thinking and worrying about the symptoms or when they may come back. We have included some distraction techniques at the end of this leaflet for you and your child to try.
• Focus on the positives – you and your child have seen a member of the cardiology team who have reassured you both that the symptoms are not cardiac in nature which is really positive.
  If your child has another episode of these symptoms, but manages to cope by using a breathing or distraction technique, praise your child on this and focus on the positive that they were able to manage and cope.
• Self-care – taking 5 – 10 minutes of the day for self-care can help you to cope when things are tough and can help manage feelings like anxiety and low mood. We have included a QR code below to our self-care information sheet which includes self-care ideas for both children and adults.

Below, there are some mindfulness, breathing and distraction techniques for you and your child to try. You may prefer some over others, so it’s helpful to find what you and your child enjoy the most. It is best practice to set 5 – 10 minutes aside each day to do these. We would encourage you and your child to use these when they are experiencing symptoms to stay calm and feel in control.

Mindfulness techniques

The 5 senses noticing task – notice what is happening in the present moment using each of your senses:

1. Thing you can taste
2. Things you can smell
3. Things you can feel
4. Things you can hear
5. Things you can see

Mindful walk – take the family on a mindful walk, use your senses to notice the changes in nature all around you

• Start by noticing how your body moves and feels with each step.
• Expand your awareness to your surroundings.
• What do you see?
• What do you hear?
• What do you smell?
• What do you feel?
• Mindful walking can create feelings of wellbeing, provide better sleep, improve mood and manage stress.

Mindful colouring – mindful colouring helps to shift our focus into the present by concentrating on colouring.

• Please view the PDF for a selection of shapes to colour.

Breathing techniques

Try out different calm breathing techniques below. Once your child has practiced calm breathing, repeat these up to 10 times.

• Breathe in through your nose like you’re smelling a flower.
• Breathe out through your mouth like you are blowing out these birthday candles.
• Box Breathing
  – Breathe in (4 seconds)
  – Hold (4 seconds)
  – Breathe out (4 seconds)
  – Hold (4 seconds)
• Star Breathing
  Breathe in
  Breathe out
  Breathe in
  Breathe out
  
• Star Breathing
  Breathe in
  Breathe out
  Breathe in
  Breathe out
  
• Star Breathing
  – Breathe in
  – Breathe out
  – Breathe in
  – Breathe out
  – Breathe in
  – Breathe out
  – Breathe in
  – Breathe out

Distraction techniques

• Name animals alphabetically
  – A for ant, B for bear, …
• Name 10 different colours
  – Name 10 more different colours that you didn’t say the first time
• Say the alphabet backwards
• Draw what you hear
• Practice timetables in your head
• Notice what cars are passing by – colour, make
• Listen to music, radio or podcast
• Read

Resources and useful links

Helplines