After ensuring a child's cardiac examination is normal, which step is appropriate if they report syncope?

In the context of a child reporting syncope, if the cardiac examination has been determined to be normal, the most appropriate next step is to monitor without immediate intervention. This approach takes into consideration that syncope in children can often be benign and self-limiting, especially when no underlying cardiac pathology is present.

Monitoring allows for observation of the child's condition over time, which can help in assessing whether the syncope is an isolated event or part of a recurring pattern. A conservative approach is often preferred initially, as many cases of syncope are related to vasovagal responses or other non-cardiac causes that do not require invasive testing or immediate intervention.

Other options such as ordering a sleep study or providing a referral to a psychiatrist may be indicated in certain scenarios based on a detailed history suggesting other underlying conditions, but they are not first-line responses when a normal cardiac exam has been performed. Completing a sports physical examination may be pertinent at a later stage if the child's syncope impacts their ability to participate in sports, but it doesn't directly address the immediate concern of syncope. Thus, the decision to monitor without intervention is both prudent and aligned with clinical guidelines for handling such cases in pediatrics.