Syncope is a common complaint in pediatrics and is rarely caused by a cardiac issue in patients with a normal physical examination. If the episode is caused by the heart, it generally is an issue with the heart rhythm. Therefore, an echocardiogram rarely adds diagnostic value and it increases cost of care. In situations in which an echocardiogram may be warranted (syncope that occurs in the circumstance of an abnormal ECG, exertional syncope, unexplained postexertional syncope, or syncope in the setting of a concerning family history*), consultation with a pediatric cardiologist is recommended prior to obtaining the echocardiogram. Therefore, it is important to obtain a thorough personal and family history,* physical examination, and ECG when indicated prior to proceeding with echocardiography in the initial assessment of pediatric syncope. (*Family history should assess specifically for the following types of cardiovascular diseases: connective tissue disorders; cardiomyopathies; arrhythmias, including need for pacemaker or defibrillator implantation; storage diseases; sudden unexplained death; premature cardiovascular disease prior to the age of 50 years.)