blackouts and other paroxysmal events in children under 16 years - NICE guidance - suspected neurological conditions - recognition and referral

Last edited 05/2019 and last reviewed 07/2023

Blackouts and other paroxysmal events

Summary points from NICE guidance relating to blackouts and other paroxysmal events in children are:

Blackouts and vacant spells

• refer urgently children with new-onset blackouts (transient loss of consciousness) accompanied by seizure markers for neurological assessment, in line with the recommendation for people with suspected epilepsy in the NICE guideline on transient loss of consciousness ('blackouts') in over 16s (see linked item)
  
  
• refer urgently children with mid-activity vacant spells or behavioural outbursts associated with altered consciousness or amnesia for the events to have a paediatric assessment.

Blackouts in children under 12 years

• refer urgently all children aged under 12 years with blackouts for paediatric assessment.

Vasovagal syncope

• do not routinely refer children aged over 12 years with blackouts if there are clear features of vasovagal syncope, even if associated with brief jerking of the limbs, in line with recommendation on uncomplicated faint in the NICE guideline on transient loss of consciousness ('blackouts') in over 16s (see linked item)

Blackouts, seizures or amnesia after a head injury

• for children who have blackouts, seizures or amnesia for events after a head injury then requires immediate hospital review

Reference:

• NICE (May 2019). Suspected neurological conditions: recognition and referral