Abstract: Objectives To analyze and compare the clinical features of autonomic nervous mediated syncope (NMS) and pseudo psychogenic syncope (PPS) in children. Methods Clinical features were retrospectively analyzed in children with syncope complaint not caused by cardiac syncope, situation of syncope, drug-induced syncope, and neurogenic and metabolic diseases that caused brief loss of consciousness, and the clinical features of similarities and differences between NMS and PPS were compared. Results In 106 children with syncope were included, there were 85 cases (80.2%) of NMS, 13 cases (12.3%) of PPS, and 8 cases (7.5%) of unexplained syncope. PPS was induced by recent mental stimulation; the syncope was more frequent; the score of orthostatic intolerance was higher; the omen was rare; the duration of attack was longer. NMS was induced by long time standing, movement and body position change; the omen was mainly dizziness, blurred vision and gastrointestinal symptoms; the duration of attack was short ( ＜ 5 min). Conclusions NMS is the most common cause of syncope in children, while PPS is an important cause of transient consciousness of non-syncope. There are similarities in clinical features between NMA and PPA and differential diagnosis is needed.