On several occasions in paediatric practice we come across unusual mannerisms, perceptions, and behaviour in infants, children, and teenagers, causing considerable concern. Many are dramatic, uncharacteristic, or repeated and finding an explanation can be difficult. Young children take to head banging, head rolling, body rocking, bedwetting nightmares, or grinding their teeth. Adolescence brings on obsessions, compulsions, and self-injurious or self-stimulating behaviour. Medical evaluation hopes to make or refute a proposed diagnosis of seizures (or fits) and to provide treatment or reassurance as necessary.
Fits have several subtle and confounding atypical manifestations and many conditions mimic a fit. This is one area wherein paediatricians wait before putting a label on the child and are used to not having all the answers. Some events cannot be classified and we wait after a full assessment is performed and follow up the child till the benign nature of the events is apparent. And then we agree on channels for parents to seek reassessment if the situation changes. During this time, the parents are asked to keep a careful record of the circumstances of their attacks and eye-witness descriptions.
One common condition causing alarm is fainting (technically called the syncope).This is caused by a sudden reduction in blood flow to the brain, or from a drop in its oxygen content (or a combination of the two). Specific immediate triggers for fainting are a minor injury, procedures like immunisation or blood tests (or even seeing blood), standing still or standing from sitting after a long time, sudden surprises/shocks, exercise, etc. Premonitory symptoms include light-headedness, feeling hot and sweaty, nausea and not uncommonly, visual disturbance. When loss of consciousness occurs, there may be associated loss of muscle tone often with a relatively gradual rather than an abrupt onset (‘swoon’) but many will have anoxic fits with stiffening and jerking of the body. This does not qualify as a seizure disorder and is usually not treated. However a tongue bite, passing of urine or stools in unawareness or a prolonged confusion after recovery is suggestive of a fit and will require more investigations.
What is important is to remember that fainting can be a symptom of abnormal heart function (disturbances in rhythm or musculature) which could cause sudden death if not treated. Therefore all children with recurrent or unexplained fainting should have a standard cardiac evaluation (especially if there are reports of sudden deaths in young adults in the family).