event lasted less than one minute, and 80% had prodromal symptoms. The syncope episodes occurred while standing (48%), abrupt stand-up (19%), seating (14%), walking (14%) and during or immediately after exercising (9%).Psychological stress (24%), hyperventilation (10%), trauma or blood-work (19%) were often present. 28% had previously known headache, migraine, diabetes and rhythm disorders.ECG was conducted in 70% (2% pathological), EEG in 20% (1% pathological) and blood work in 57% (6% pathological). Neuropediatric (13%), cardiologic (12.9%) and psychiatric (6%) examinations were performed (0, 1% and 2% pathological, respectively). 22% were admitted in the hospital for further diagnostics and treatment due to diagnostic dilemma, recurrent syncope or new symptoms.At release, 70.8% were diagnosed with reflex syncope (63.5% vasovagal and 7.3% situational), hyperventilation (7.3%), heat illness (4.1%), pseudo syncope (4.2%), breath holding spells (4.2%), orthostatic syncope (3.1%), convulsions (3.2%), toxin exposure (2.1%) and anaphylaxis (1%).The majority of the children experiencing syncope in pediatric ED were not life endangered by cardiac or other underlying etiology. A potentially life-threatening was an anaphylactic shock, toxin exposed children, heat syncope and exercise associated collapse. Based on a detailed history, clinical exam and specific diagnostic procedures, specialists in ED should recognize specific conditions that require attention.