Head neck and nervous system

Stroke in Babies and Children

“Stroke” is an injury to the brain or the blood vessels in the brain. If a blood vessel is blocked, it can’t deliver oxygen or nutrients to the brain.

Unlike other parts of the body, the brain cannot survive for long without blood flow – if an area of the brain runs out of oxygen or energy, it can become injured or even die.

This is an “ischemic stroke.” A “venous sinus thrombosis” happens when a blood clot forms in one of the veins in the head. Another type is a “hemorrhagic stroke,” which is bleeding inside the head.

Stroke is an emergency—if you think your child is having a stroke, call 911!

Children have strokes?

Strokes are less common in babies and kids than in adults, but they do happen! Babies have a higher risk than children or teenagers.

What causes a stroke in children?

Children have strokes for different reasons than adults. Premature babies may have brain bleeds because their blood vessels are very fragile. Babies have blood that clots more easily than older kids, which can cause stroke in the weeks around birth.

Blood diseases, like sickle cell or hemophilia, can also cause stroke. Genetic diseases that affect the blood vessels or the blood can cause stroke in kids of any age. Other children might have a stroke after injuries to the head or neck if they damage the blood vessels inside. Rarely, infections can create narrowing of the blood vessels in the brain and cause a stroke. Children with heart problems are also at risk.

What are common symptoms of stroke?

Sometimes, it is hard to tell if a child is having a stroke because babies and younger kids can’t always tell us what’s happening.

In infants:

  • seizures that keep happening in one part of the body
  • sleepiness that is so severe that a baby won’t wake up to feed normally
  • weakness or stiffness on one side of the body or in one arm or leg. One sign can be a hand preference before your baby turns one. Other children may have developmental delays.

In children:

  • sudden weakness on one side of the face and body, or not using one side of the body normally
  • falling to one side repeatedly
  • new difficulty talking – slurred speech (“like they are drunk”), no words coming out, or words that do not make sense
  • loss of feeling in one side of the body or face
  • vertigo (“feeling like the room is spinning or moving”) with balance problems and difficulty walking or double vision
  • sudden, very bad headache that is different from your child’s normal headaches

How is stroke diagnosed?

If you think a child is having a stroke, call 911 or go to your nearest emergency department.

A doctor will talk to you and examine your child. Depending on what they see, your child may have some of these tests:

  • pictures of your child’s brain and of the blood vessels in the head and neck with a CT or an MRI scan
  • heart tests including an EKG or an ultrasound picture of the heart (an “echocardiogram”) to see how well it is working
  • blood tests to look for bleeding or clotting problems, infections, or blood conditions.

How is stroke treated?

In some cases, emergency treatment may be possible to stop the stroke from getting worse if a diagnosis is made within the first hours after a stroke starts. If your child had an ischemic stroke or a venous thrombosis, doctors may use aspirin or blood thinners to prevent it from getting worse or happening again. For children with brain bleeds, a neurosurgeon will work closely with your doctor to help take care of your child.

How does my child recover from a stroke?

The most important treatments for children with strokes are time and physical, occupational or speech therapy. Even though the brain does not heal as easily or as completely as other parts of the body, children’s brains can often adapt to their injuries. Through physical, speech, and occupational therapy, many kids can continue to improve for 6 or even 12 months after their stroke. Your child’s doctor and therapists will work with you to make a plan for how to best help her recover.

Can this happen again?

Overall, the risk for another stroke in childhood is low. All of us are at risk for stroke as we age, so it is important for you and your child to avoid things that increase the risk of stroke in adulthood, like high blood pressure, cholesterol, diabetes, and smoking.

Head neck and nervous system

Migraine Headaches in Children and Teens: Parent FAQs

Migraine Headaches in Children & Teens: Parent FAQs

​​​​​​​​​​Roughly 39 million people in the United States suffer from migraines. While they most often strike adults, many children also experience intense, throbbing headaches and other symptoms of migraines. Read on for helpful information about the signs, symptoms and causes of migraines and how to help children and teens dealing with them.

What is the difference between a migraine and a hea​dache?

Migraine pain usually is more severe. It often includes throbbing on one side of the head that often worsens with activity. Migraine headaches also tend to strike with other symptoms, such as nausea, vomiting, vision problems (seeing spots or flashing lights, for example), light and sound sensitivity, and tingling.

At what age can children get m​igraines?

Any child can get a migraine. About 10% of children age 5-15 and up to 28% of teens get them. Half of people who get migraines have their first attack before age of 12. Migraines have even been reported in children as young as 18 months!

​​​​Childhood mi​​​grai​nes: a coli​c connection?​Recent research suggests that children who had colic as babies may be more prone to develop migraines. One study found children with migraines were seven times more likely to have been colicky infants.​​

What are some migraine causes, risk factors and ​triggers?

Family history. Migraines tend to run in fam​ilies. If one parent has migraines, there is roughly 50% chance that their child will too. If both parents have them, the chance is close to 90%.

Gender. Before puberty, boys have more migraines than girls. That flips in the teen years and by age 17, as many as 8% of boys and 23% of girls have had a migraine. For adults, migraines are more common in women.

Stress & sleep. Irregular sleep schedules – getting too much or too little sleep – can be migraine triggers. So are changes in stress levels.

Exercise. While exercise can sometimes trigger migraines, regular exercise may help prevent or reduce the number of attacks.

Food & fluids. Skipping meals and eating certain foods and additives can set off migraines. Common triggers include aged cheeses and meats, chocolate, citrus fruits, red and yellow food dyes, monosodium glutamate (MSG), and the artificial sweetener aspartame. Too much caffeine and spicy foods can also trigger migraines, but sometimes help headaches because they act as vasodilators and expand blood vessels. Not drinking enough water and other beverages can cause dehydration, another migraine trigger.

Weather. Stormy weather with changes in barometric pressure, extreme heat or cold, bright sunlight and glare, high humidity or very dry air all can be triggers.

Are there differen​​t stages of migraines?

Migraines often develop in stages:

  1. Premonitory or warning phase: tiredness, stiff neck, mood changes (can last up to 24 hours).
  2. Aura: seeing spots, squiggly lines, dizziness, weakness, numbness and/or confusion. These symptoms, which don’t happen with all types of migraines, may last up to an hour.
  3. Headache or attack: severe, throbbing/pulsating pain with nausea, vomiting and light sensitivity.
  4. Resolution: sleep ends the headache pain for some children.
  5. Recovery: feeling tired (lasts hours to days).

How is a m​igraine diagnosed?

The diagnosis of a migraine​ is usually based on a thorough medical history along with physical and neurological exams. Occasionally, tests like bloodwork, MRI or lumbar punctures may be recommended.

​Mild, m​ode​​rate ​or s​​evere?​To measure how strongly migraines impact a child’s school, home, and social activities, pediatricians and pediatric neurologists use a tool called the Pediatric Migraine Disability Assessment (PedMIDAS), which consists of 6 questions:In the last three months, how many…​
Full days of school were missed due to headaches?Partial days of school were missed due to headaches?Days did you function at less than half your ability in school because of a headache?Days were you not able to do things at home (e.g., chores, homework, etc.)?Days you did not participate in other activities due to headache (e.g., play, go out, sports, etc.)?​​Days did you participate in these activities, but functioned at less than half your abilities?The total number of days are then added up. A score of less than 10 is considered little or no impact; 11-30 is mild; 31-50 is moderate, and more than 50 is severe.

How are mig​​raines treated?

Lifestyle changes. Keeping healthy, regular routines can help prevent or reduce the frequency and severity of migraines:

  • Sleep hygiene. Children, especially those with migraines, should get 8-10 hours of sleep daily. If your child has trouble sleeping, your pediatrician may recommend tests to monitor for snoring or sleep disorders, which have been linked to migraines. Make sure TVs, cell phones, tablets and other media devices are turned off an hour before bedtime, since they can interfere with sleep.
  • Healthy diet. Eat three regular meals each day at consistent times. Avoid heavily processed foods, which tend contain more migraine triggers like additives and artificial colors and sweeteners. Drink plenty of water and other healthy beverages to stay hydrated.

​Helpful tip: keep a headach​e d​iar​yIf your child has migraines, keeping a headache diary can help you start to recognize triggers and see which therapies are most helpful. Simply write down when the headache started, where the pain was located, how severe the pain was, how long it lasted, any other symptoms, and if medications were effective. You may also want to keep track of how much sleep your child had, meals, fluids as well as weather changes and amounts of exercise and stress.​

Acute medications. Your child’s doctor may recommend or prescribe medications that can help during a migraine attack. These work best when taken at the first sign of an attack. Keep in mind that medication overuse headaches may start if these are used daily or frequently. Examples of medicines that can help during a migraine include:

  • Analgesic pain medicines such as acetaminophen and products that combine ​acetaminophen, aspirin and caffeine, and nons​teroidal anti-inflammatory medicines such as ibuprofen and naproxen.
  • Triptans, a category of drugs called selective serotonin receptor agonists. Evidence shows that combination sumatriptan/naproxen tablets and zolmitriptan nasal spray can stop headache pain within two hours.

Preventive medications. There are some medications that when taken daily can help reduce the severity and/or frequency of migrainesThese tend to be “off-label,” meaning they are not approved by the U.S. Food and Drug Administration for migraines. Their risks and benefits should be discussed with your doctor. Options include:

  • Cardiovascular drugs: propranolol
  • Antidepressants drugs: amitriptyline
  • Anti-seizure drugs: topiramate
  • Antihistamines: cyproheptadine
​Do Botox treatments help children with Migraines?​​​Although botulinum toxin (Botox) is approved and shown to be effective for adults who get chronic migraines, a recent American Academy of Neurology report found that it is not effective for children and teens.

Are there any alternative therapies​​ shown to help migraines?

There are some alternative or natural and non-pharmaceutical approaches to migraine treatment that may help. These include:

Cognitive behavioral therapy (CBT), which focuses on coping skills, positive thinking, sticking to healthy habits, and relaxation techniques to help ease migraine pain. Research also has found that CBT combined with migraine medications is more helpful in treating migraines that medication alone.

Herbs, vitamins and minerals. Certain extracts and supplements may help with migraines, although some should be avoided for safety reasons. Talk with your child’s doctor before using any herbal or vitamin supplements. Common supplements include:

  • Feverfew: this plant contains parthenolide, which some small studies suggest may help prevent migraines in some people. However, the evidence remains mixed.
  • Riboflavin (vitamin B-2), coenzyme Q10 and magnesium supplements may decrease the frequency of migraines.
  • Butterbur extract: plant containing petasins is NOT recommended because of long-term liver disease risk.

How can I help my child avoid missing s​​chool from migraines?

Children who suffer from migraines are absent from school twice as often as other students. Talk with your child’s teachers and school nurse about ways to help avoid missed class time. A letter from the doctor explaining your child’s diagnosis and the medications they take when they feel a migraine coming on can help the conversation. Helpful accommodations may include making sure your child has ready access to water and snacks, for example.

Head neck and nervous system

Meningitis in Infants and Children


​Meningitis is an inflammation of the tissues that cover the brain and spinal cord. The inflammation sometimes affects the brain itself. With early diagnosis and proper treatment, a child with meningitis has a reasonable chance of a good recovery, though some forms of bacterial meningitis develop rapidly and have a high risk of complications.

Types of meningitis: viral and bacterial

Thanks to vaccines that protect against serious forms of bacterial meningitis, today most cases of meningitis are caused by viruses. The viral form usually is not very serious, except in infants less than three months of age and with certain viruses such as herpes simplex, which typically causes another serious infection. Once meningitis is diagnosed as being caused by a virus, there is no need for antibiotics and recovery should be complete. Bacterial meningitis (several types of bacteria are involved) is a very serious disease. It occurs rarely in developed countries (because of the success of vaccines), but when it does occur, children under the age of two are at greatest risk.

The bacteria that cause meningitis often can be found in the mouths and throats of healthy children. But this does not necessarily mean that these children will get the disease. That doesn’t happen unless the bacteria get into the bloodstream.

Children at higher risk of meningitis

We still don’t understand exactly why some children get meningitis and others don’t, but we do know that certain groups of children are more likely to get the illness. These include the following:

  • Babies, especially those under two months of age (Because their immune systems are not well developed, the bacteria can get into the bloodstream more easily.)
  • Children with recurrent sinus infections
  • Children with recent serious head injuries and skull fractures
  • Children who have just had brain surgery
  • Children with cochlear implants

With prompt diagnosis and treatment, 7 out of 10 children who get bacterial meningitis recover without any complications. However, bear in mind that meningitis is a potentially fatal disease, and in about 2 out of 10 cases, it can lead to serious nervous-system problems, deafness, seizures, paralysis of the arms or legs, or learning difficulties. Because meningitis progresses quickly, it must be detected early and treated aggressively.

Notify your pediatrician immediately if your child displays any of the following warning signs:

  • If your child is less than two months old: A fever, decreased appetite, listlessness, or increased crying or irritability warrants a call to your doctor. At this age, the signs of meningitis can be very subtle and difficult to detect. It’s better to call early and be wrong than to call too late.
  • If your child is two months to two years old: This is the most common age for meningitis. Look for symptoms such as fever, vomiting, decreased appetite, excessive crankiness, or excessive sleepiness. (His cranky periods might be extreme, and his sleepy periods might make it impossible to arouse him.) Seizures along with a fever may be the first signs of meningitis, although most brief, generalized (so-called tonic-clonic) convulsions turn out to be simple febrile seizures, not meningitis. A rash also may be a symptom of this condition.
  • If your child is two to five years old: In addition to the above symptoms, a child of this age with meningitis may complain of a headache, pain in his back, or a stiff neck. He also may object to looking at bright lights.

Treatment for meningitis

If, after an examination, your pediatrician is concerned that your child may have meningitis, she will conduct a blood test to check for a bacterial infection and also will obtain some spinal fluid by performing a spinal tap, or lumbar puncture (LP).

This simple procedure involves inserting a special needle into your child’s lower back to draw out spinal fluid. This is usually a safe technique in which fluid is sampled from the bottom of the sac surrounding the spinal cord. Signs of infection in this fluid will confirm that your child has bacterial meningitis. In that case he’ll need to be admitted to the hospital for intravenous antibiotics and fluids and for careful observation for complications.

During the first days of treatment, your child may not be able to eat or drink, so intravenous fluids will provide the medicine and nutrition he needs. For bacterial meningitis, intravenous antibiotics may be necessary for seven to twenty-one days, depending on the age of the child and the bacteria identified. If prolonged antibiotics are needed, your child may be able to continue receiving medication in the comfort of your own home. Most children with viral meningitis improve within seven to ten days without antibiotics. Children will typically recover at home with rest, fluids, and over-the-counter pain medications, although some might need to be treated in the hospital.


Some types of bacterial meningitis can be prevented with vaccines. Ask your pediatrician about the following vaccines.

Hib (Haemophilus influenzae type b) Vaccine

This vaccine will decrease the chance of children becoming infected with Haemophilus influenzae type b (Hib) bacteria, which was the leading cause of bacterial meningitis among young children before this immunization became available. The vaccine is given by injection to children at two months, four months, and six months, and then again between twelve and fifteen months of age. (Some combined vaccines may allow your doctor to omit the last injection.)

Meningococcal Vaccine

There are two kinds of meningococcal vaccines available in the US, but the preferred vaccine for children is called the meningococcal conjugate vaccine (MCV4). Although it can prevent four types of meningococcal disease, it is not routinely recommended for very young children, but rather for young adolescents (eleven to twelve years of age), or teenagers at the time they start high school (or at fifteen years old).

Pneumococcal Vaccine

This vaccine is effective in preventing many serious infections caused by the pneumococcus bacteria, including meningitis as well as bacteremia (an infection of the bloodstream) and pneumonia. It is recommended starting at two months of age, with additional doses at four, six, and between twelve and fifteen months of age. Some children who have an increased susceptibility to serious infections (these high-risk children include those with abnormally functioning immune systems, sickle cell disease, certain kidney problems, and other chronic conditions) may receive an additional pneumococcal vaccine between ages two and five years.

Head neck and nervous system

Headaches: When to Call the Pediatrician

Headaches: When to Call the Pediatrician

“My head hurts.” Across the U.S., parents hear this complaint from their children and teenagers at a rate so frequent that it can be hard to know whether it is, in fact, a painful headache (or just an excuse to stay home from school). Head pain in babies and children too young to tell you their head hurts are often fussier, crankier, and unable sleep.

While most headaches are harmless and go away within a few hours, recurrent headaches of any type can cause school problems, behavioral problems, and/or depression. In this article, learn when to involve your pediatrician. It’s important to know when headaches may be a symptom of something more serious.  

Home Care for Children’s Headaches

Anyone who has ever had a mild, occasional headache knows rest and relaxation is often the best treatment. Other things like ice packs, warm shower or baths, naps in a dark room, and head and neck massage may also help.

Use Caution with Over-the-Counter Pain Medicine
Don’t be tempted to turn to over-the-counter pain medication every time your child complains of head pain. If you do, be sure to always read the label for any medication to determine the right dose based on your child’s weight.Acetaminophen (Tylenol): You can give your child one dose to help reduce headache. Do not exceed the maximum dosage and frequency for children, 22-33 milligrams per pound within a 4-hour period.Ibuprofen (Motrin/Advil): If acetaminophen does not initially work, you can also give one dose of ibuprofen. Do not exceed the maximum dosage and frequency for children, 13-22 milligrams per pound within a 12-hour period.Keep track of how often you are giving these medications. If you are using more than 3 doses total per week, consult your pediatrician to determine if other medication is required.Using more than three doses per week can also lead to medication overuse headaches (also known as analgesic rebound headaches). Children and teenagers can get these types of headaches from taking pain medicine too often, and therefore, being dependent on the medication. The over-the-counter medications no longer work to reduce pain, and the headaches become more frequent and more painful! Not good.

Keep a Headache Diary

There are a number of types of headaches, as well as potential causes. So, it can be helpful to see if a pattern develops. There are many different apps and online tools available to help you and/or your child. Your pediatrician will use this information to determine the best course of treatment.

What to include in a headache diary?

  • Date and time of headache
  • How long did the headache last?
  • What symptoms did your child experience?
  • What helped relieve the pain?
  • What made the pain worse?
  • Did anything specific happen that day (a test coming up in school, infectious symptoms, eating a certain food, trouble sleeping, etc.)?

Common Types of Headaches:

Each type of headache may be treated differently. A detailed history and physical exam help your pediatrician figure out what kind of headache your child has. Based on your child’s diagnosis, your pediatrician will create a plan with you on how to best relieve your child’s pain.

 Common symptoms:Call pediatrician if your child has:Seek emergency care if your child has:
Tension headachesMild or moderate headacheTypically develops during the middle of the dayConstant, dull or achy painSensation of tightness that feels like a band or circle around the headPain located in the forehead or on both sides of the headNeck painFatigue Daily headachesHeadaches caused by straining from coughing, sneezing, running or having a bowel movement.Headaches that occur along with pain in the eye or ear, confusion, nausea or vomiting, sensitivity to light and sound, or numbness.Headaches that keep coming back and get worse.
Headaches following a head injury that don’t go away after a week.Headaches severe enough to wake from sleep.

​ ​
Sudden, severe head pain happening for the first time–especially if your child has double vision, seems confused, sleepy, hard to wake up, has numbness or projectile vomiting.Headache with a stiff neck, or complaints of neck pain, especially with a fever.

Migraine headachesThrobbing pain that is often on one side of head, but can be on both sides–particularly in childrenLight and/or noise sensitivityFatigueNausea and vomitingMood changesAn aura: flashes of light, zig-zag lines or other odd vision changes that may appear before or during a migraineNote: Some symptoms of a migraine may be slightly different in children than adults.
Congestion headachesPain and pressure above a sinus, often above the eyebrow, behind the eye, and under the cheekbonePain may be on just one side of the face/headBlocked or runny nose
Medication overuse (analgesic rebound headaches)Pain starting behind the eyes and moving up the front of the head, or dull ache around the foreheadGrogginessIrritability
Flu-like aches and painsMay start after pain reliever use endsCaffeine in sodas and energy drinks can also be a culprit
Headaches after a head injuryPain that feels like pressure inside the headDizzinessMental fogginessNauseaFatigueMoodinessBlurry vision

Does my child need a CT-scan?

Imaging of the brain, blood tests and invasive procedures are NOT required to diagnose headaches. In some cases, brain imaging or a lumbar puncture is needed if a more serious condition is suspected. If necessary, the pediatrician will discuss what further tests are needed and why. The pediatrician may also recommend that your child see a pediatric neurologist who can help provide further recommendations for your child’s headache.


Many times, when children get headaches, they’ll be gone as quickly as they come. Rest, rehydration, and healthy routines will usually keep them go away. But, be sure to call your pediatrician any time you have concerns about your child’s headache pain.

Head neck and nervous system

Dizziness and Fainting in Children and Teens

Dizziness and Fainting in Teens

Passing out or fainting―also known by the medical term syncope―is common among young people, especially teenagers.

As many as 1 in 4 healthy children and adolescents have fainted at some point. Has your child?

Although the experience can be frightening, it’s usually not caused by anything serious. Most young people recover quickly after fainting, typically in less than one minute.

It’s important for parents to learn about common fainting triggers such as dehydration and get prompt treatment when needed. A visit to the pediatrician or cardiologist may be necessary to rule out rare but potentially serious causes of fainting.

What causes a healthy child to faint?

Most often, fainting happens in otherwise healthy children when there is a temporary drop in the flow of oxygen-rich blood to the brain (blood pressure). Usually, the child recovers quickly. This is called simple fainting.

The choking game: beware of dangerous internet challenges!The  “choking game,” the “fainting  game,” “pass out,” and “blackout”―names of a few of the dangerous internet challenges on social media where kids try to fainting on purpose. The “challenge” involves cutting off blood and oxygen to the brain by wrapping a belt or a similar object around the neck to experience a “high” when letting go.Statistics compiled by the non-profit group Games Adolescents Shouldn’t Play (GASP) show hundreds of adolescents worldwide have died from the choking game during the past two decades. Middle school students with symptoms of depression or behavior problems may be at an especially high risk of playing the choking game, according to a recent study.Signs your child might be trying it include bloodshot eyes and frequent headaches. Talk with your kids about how internet challenges that may seem harmless and funny can easily land them in the emergency room.

Triggers for simple fainting can include:

  • Not drinking enough fluids―especially during hot weather or in overheated spaces. Dehydration is the most common cause of fainting in children. Not drinking enough fluids also reduces blood volume and lowers blood pressure.
  • Standing still for a long time in one place. This can cause the blood to pool in the legs because of gravity or standing up quickly.
  • Overheating―especially in overcrowded environments.
  • Strong emotions in response to pain, blood, or something shocking or scary. This can cause the part of the brain that controls blood pressure, breathing rate, and heart rate to suddenly switch gears and get out of sync.
  • Hyperventilating or breathing too fast. This can happen due to anxiety or fear, because it causes rapid changes in our blood supply to the brain.  
  • Breath-holding spells. These are common in young children during temper tantrums or when they are in pain. Breath-holding spells generally are not serious, and most children outgrow them by 6 years of age.
  • Certain movements, such as coughing, swallowing, weight lifting, going to the bathroom, or even hair-grooming may stretch or press on sensitive nerve endings. This trigger is rare and usually affects teens; with the vast majority outgrowing it.

What are some warning signs and symptoms before fainting?

About 5 to 10 seconds before fainting, there are a number of warning signs including:

  • Dizziness or lightheadedness
  • Nausea
  • A surge of warmth and sweating, or sudden cold feeling
  • Blurry or spotty vision
  • “Ringing” in the ears
  • Pale or ashy appearance
  • Faster heart rate (called  tachycardia)

If my child has fainted before, should I tell her teachers and coaches?

Yes. They can help watch for signs and help her to the floor if it happens again and help avoid risks like having her stand at the end of a row in crowded bleachers.

What to do when a child faints:1.      If possible, try to catch and ease a child to the floor.2.      Have the child raise both legs for 10 minutes while lying down.If the child has food in her mouth, lay her on her side with her face turned toward the floor so she does not choke on the food.3.    Call 911 or go to the nearest emergency department if the child:Isn’t waking up after a short amount of time
Has injuries from the fall and is bleeding a lot
Fainted suddenly after taking medicine, being stung by an insect, or eating something she may be allergic to
Was exercising when they fainted
Is having trouble breathing, talking, or moving

Can fainting be a sign of a more serious medical condition?

In some cases, fainting can be a sign of an underlying health problem or condition, such as:

  • Iron-deficiency. Anemia, when there’s insufficient iron in the blood to deliver enough oxygen to brain, can cause of fainting in rapidly growing teens—especially girls who get heavy periods.
  • Internal bleeding. A blow to the head (such as a concussion) or belly.
  • Diabetes. Sudden drops in blood sugar can cause fainting. The brain needs sugar for energy. Diabetes also can cause increased urination that leads to dehydration. If a child with diabetes faints, it is considered a diabetic emergency. Use this form from “Helping the Student with Diabetes Succeed: A Guide for School Personnel” to prepare a hypoglycemia emergency care plan.
  • Eating disorders. Anorexia and bulimia can cause fainting from dehydration, low blood sugar, and changes in blood pressure or circulation caused by starvation, vomiting, or over exercising.
  • Heart issues. Irregular heartbeats (cardiac arrythmia) or structural problems (heart or valve) can cause fainting. Fainting that happens during exercise always needs medical follow-up.
  • Migraines. Fainting is a symptom of certain types of migraine headaches.
  • Alcohol and drug use. Alcohol makes blood vessels dilate or widen which can cause the blood pressure to drop. Some illegal drugs, like methamphetamines, affect heart function and can lead to fainting.
  • Pregnancy. Changes to the circulatory system in pregnancy can affect blood pressure and increase the body’s need for fluids.
  • Postural orthostasis tachycardia syndrome (POTS). This condition affects an estimated 1 in 100 teens who get a rapid heartbeat and lightheadedness or fainting when standing, especially after lying down. Episodes often start after viral illness, trauma, or major surgery.
  • Addison’s Disease/adrenal insufficiency. Children with this condition don’t produce enough hormones, such as cortisol, that help control the response to stress, blood pressure, and blood sugar levels.

How is more serious fainting diagnosed and treated?

For child who faints on several occasions, or if there are signs of a more serious medical condition, your pediatrician may refer your child to a pediatric cardiologist. While there, your child may receive various kinds of heart tests.

Red flag symptoms of possible heart issues with fainting:  

  • Fainting during exercise
  • Abnormal or especially fast heartbeats, particularly if they occur prior to fainting
  • Family history of sudden cardiac death. Your pediatrician may ask about any close relatives who died from unintentional injuries or drowning, which may have involved cardiac-related fainting.

Can I prevent my child from fainting?

Your pediatrician can recommend ways to help prevent simple fainting. 

Here are some ideas:

  • Stay hydrated and eat well. Make sure your child drinks plenty of water or other healthy beverages each day. Limit caffeine and avoid skipping meals.
  • Monitor blood pressure. If your child’s blood pressure is low or normal, your pediatrician may suggest a change in his or her diet. .
  • Flex muscles in the legs, shift positions, and bend at the waist occasionally when standing for a long time to help circulation and blood flow to the brain.
  • Take breaks from the heat. Avoid standing for long periods in warm environments, such as practice fields in the sun or crowded places. Limit time in hot showers, saunas, hot tubs, and Jacuzzis.
  • Help your child learn to recognize the early signs of fainting. When his symptoms start, remind him to put his head between his legs or lay down.

Are there medications to help prevent fainting?

Medications may be prescribed in certain cases. Some types of steroids, beta blockers, and anti-arrhythmic drugs and selective serotonin reuptake inhibitor (SSRI) anti-depressants may help some patients. More research is needed to determine the effectiveness of these medications in children and teens.


Most children and teens who faint recover quickly and without any lasting harm. Knowing how to help prevent fainting spells, like getting plenty of fluids, can help avoid the scary experience of passing out. Any time your child does faint, be sure to tell your pediatrician.

Head neck and nervous system

Car Sickness

My child gets sick in the car quite often. How can we keep this from happening?

Motion sickness occurs when the brain receives conflicting signals from the motion-sensing parts of the body: the inner ears, the eyes, and nerves in the extremities. Under usual circumstances, all three areas respond to any motion. When the signals they receive and send are inconsistent—for example, if you watch rapid motion on a movie screen, your eyes sense the motion, but your inner ear and joints do not—the brain receives conflicting signals and activates a response that can make you sick. The same thing can happen when a child is sitting so low in the backseat of a car that she cannot see outside. Her inner ear senses the motion, but her eyes and joints do not.

Signs and symptoms

Motion sickness usually starts with a vague feeling of stomach upset (queasiness), a cold sweat, fatigue, and loss of appetite. This usually progresses to vomiting. A young child may not be able to describe queasiness, but will demonstrate it by becoming pale and restless, yawning, and crying. Later she will lose interest in food (even her favorite ones), and even vomit. This response can be affected by previous car trips that made her sick, but it usually improves over time.


We do not know why motion sickness happens more often in some children than others. Since many of these children years later experience occasional headaches, there is a belief that motion sickness may be an early form of migraine.

Motion sickness occurs most often on a first boat or plane ride, or when the motion is very intense, such as that caused by rough water or turbulent air. Stress and excitement also can start this problem or make it worse.

What you can do

If your child starts to develop the symptoms of motion sickness, the best approach is to stop the activity that is causing the problem. If it occurs in the car, stop as soon as safely possible and let her get out and walk around. If you are on a long car trip, you may have to make frequent short stops, but it will be worth it. If this condition develops on a swing or merry-go-round, stop the motion promptly and get your child off the equipment.

Since “car sickness” is the most common form of motion sickness in children, many preventive measures have been developed. In addition to frequent stops, try the following.

  • If she has not eaten for three hours, give your child a light snack before the trip—which also helps on a boat or plane. This relieves hunger pangs, which seem to add to the symptoms.
  • Try to focus her attention away from the queasy feeling. Listen to the radio, sing, or talk. 
  • Have her look at things outside the car, not at books or games.

If none of the above works, stop the car, remove her from her car seat, and have her lie on her back for a few minutes with her eyes closed. A cool cloth on the forehead also tends to lessen the symptoms.


If you are going on a trip and your child has had motion sickness before, you might want to give her medication ahead of time to prevent problems. Some of these medications are available without a prescription, but ask your pediatrician before using them. Although they can help, they often produce side effects, such as drowsiness (which means that when you get to your destination your child might be too tired to enjoy it), dry mouth and nose, or blurred vision.

When to call the pediatrician

If your child has symptoms of motion sickness at times when she is not involved with a movement activity—particularly if she also has a headache; difficulty hearing, seeing, walking, or talking; or if she stares off into space—tell your pediatrician about it. These may be symptoms of problems other than motion sickness.

Head neck and nervous system

AFM: What We Know About This Paralyzing Illness

​Acute flaccid myelitis (AFM) is a rare but serious illness that can cause sudden weakness of muscles, loss of reflexes, and paralysis. Three spikes in cases of AFM have occurred in the United States—in late summer to early fall of 2014, 2016, and 2018—with over 660 confirmed cases. Most of the AFM cases in these outbreaks have been in children around 5 years old.

While the condition sounds frightening, keep in mind that AFM is very rare. The chances of a child getting it are less than one in a million.

What causes AFM?

Several viruses (for example, West Nile virus) are known to cause AFM, but experts agree that these new spikes in AFM cases have been caused by non-polio enteroviruses such as enterovirus D68 (EV-D68). These viruses typically cause just a mild cold. They are common in late summer and early fall, coinciding with these latest AFM spikes. In 2014, there was a rise in AFM cases during an EV-D68 outbreak. Since that 2014 outbreak, enteroviruses have been the most commonly identified viruses in lab samples from patients who had AFM.

How to protect your children?

Since we don’t know why some children develop this condition after a common viral respiratory infection and others don’t, right now there are no specific actions to prevent AFM. The best thing you can do to protect your children from getting sick from any virus is to keep up with the basics:

  • Frequent handwashing
  • Staying up to date on routine childhood and adult immunizations
  • Keeping household surfaces clean by sanitizing and disinfecting
  • Keeping your children home from child care or school when they are sick
  • Wearing insect repellent when mosquitos are near

Immediately seek medical care if your child develops sudden arm or leg weakness, a droopy face, or has difficulty swallowing or speaking.

Parent to ParentHow a Summer Cold Led to Rare AFM Diagnosis
By Rachel Scott

We all have a picture in our minds of how our lives as a family will unfold. Toddlers learning to walk. Pictures on the porch on the first day of school. But lives can be derailed in a thousand different ways. For us, it was when our perfectly healthy 5-year-old son, Braden, was suddenly paralyzed over the 4th of July holiday in 2016.
He’d had a cold the week prior. On the 4th he was lethargic and couldn’t keep food down. We were so busy with the festivities that we didn’t pause to take his symptoms very seriously. We now know that his swallowing muscles were being paralyzed—and that paralysis was gradually spreading through his body. Five days later, the paralysis reached his diaphragm and he stopped breathing. He was intubated and life-flighted to a major hospital. It was there that we got the diagnosis of acute flaccid myelitis.We had never heard of acute flaccid myelitis (AFM) before Braden’s diagnosis—and none of his doctors had ever treated a child with AFM. We learned that AFM is a rare, polio-like disease that causes limb weakness and paralysis following a cold and tends to peak in the summer of even years. We quickly became experts in all things AFM—seeking out parents who had walked this path before and advocating for treatments and therapy. It felt like we were caught in a whirlwind and dropped into a new life—new setting, new language, new everything.Braden remained in the pediatric intensive care unit (PICU) for almost two months. He needed a tracheotomy and ventilator to breathe for him, and a feeding tube to feed him. When he was stable, we were able to transfer him to a rehab facility that specializes in acute inpatient therapy for kids with trachs. Braden worked amazingly hard for almost six months before returning home.Therapy was—and continues to be—the key to Braden’s recovery. While in rehab, we learned how to care for his trach and feeding tube and developed a home therapy routine for him. He worked so hard in rehab and continued that hard work upon discharge. We’ve spent the past five years doing home therapy, outpatient therapy, and have made several return trips to inpatient therapy for an intense boost.Our lives are entirely different now. We have home nurses caring for him while he sleeps, we’ve learned how to run medical equipment and keep his body safe and healthy. His siblings have a new appreciation for disability and kids who are different. We know more about acute flaccid myelitis than we could have imagined—we know that limb weakness following a cold is a medical emergency and should be taken seriously. Today, Braden is thriving and living his best life—even if that life doesn’t match the picture we once had.
Rachel Scott is founder of the Accute Flaccid Myelytis Association and author of Alfredo’s Magic Wand: A Children’s Book About Acute Flaccid Myelitis. She’s pictured above with her family, including Braden (lower left).

Is there a treatment for AFM?

There is no specific treatment for AFM. However, doctors who specialize in neurologic and infectious diseases will tailor a treatment plan and recommend certain interventions, depending on the case. During the acute phase of the illness, most of the treatment is supportive—helping the child to breath, for example. Many children with AFM have also benefited from early physical and occupational therapy.

A special AFM Physician Consult and Support Portal was created to connect medical professionals with neurologists specializing in AFM and other rare, complex neuro-immune disorders.

Recent U.S. AFM cases were not caused by poliovirus

While AFM is often called a “polio-like illness,” we know that the cases seen in the United States have not been caused by the poliovirus. The last time the poliovirus was found in the United States was in 1993.

Prior to the polio vaccine, which was introduced in 1955, poliovirus leading to paralytic poliomyelitis was very common in the United States. It paralyzed and killed thousands of people every year. Thanks to the vaccine, poliovirus poliiomyelitis has been eliminated in the United States. But it still occurs in other parts of the world, and it would only take one person infected with poliovirus coming from another country to bring the disease back here if we were not protected by vaccination. That’s why routine polio vaccines are still important.