Syncope is a common presentation for children in the emergency department (ED). Cardiac causes of pediatric syncope are rare but may be life threatening and have the highest risk of morbidity and mortality. An extensive workup for syncope is usually unnecessary. All children presenting to the ED with syncope should have a detailed history, physical examination, and electrocardiogram performed. These components should be used to guide further diagnostic studies and subspecialty referrals. Cardiology consultation or referral should be considered if a cardiac etiology is suspected due to "red flags" identified during the history, physical examination, or electrocardiogram. An algorithmic approach to the evaluation of pediatric syncope in the ED is recommended.
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