Pediatric Disorders of Orthostatic Intolerance
Open accessAbstract
Orthostatic intolerance (OI), having difficulty tolerating an upright posture because of symptoms or signs that abate when returned to supine, is common in pediatrics. For example, ∼40% of people faint during their lives, half of whom faint during adolescence, and the peak age for first faint is 15 years. Because of this, we describe the most common forms of OI in pediatrics and distinguish between chronic and acute OI. These common forms of OI include initial orthostatic hypotension (which is a frequently seen benign condition in youngsters), true orthostatic hypotension (both neurogenic and nonneurogenic), vasovagal syncope, and postural tachycardia syndrome. We also describe the influences of chronic bed rest and rapid weight loss as aggravating factors and causes of OI. Presenting signs and symptoms are discussed as well as patient evaluation and testing modalities. Putative causes of OI, such as gravitational and exercise deconditioning, immune-mediated disease, mast cell activation, and central hypovolemia, are described as well as frequent comorbidities, such as joint hypermobility, anxiety, and gastrointestinal issues. The medical management of OI is considered, which includes both nonpharmacologic and pharmacologic approaches. Finally, we discuss the prognosis and long-term implications of OI and indicate future directions for research and patient management.
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Noncardiovascular POTS symptoms are not directly related to the observed haemodynamic disorders.
“These symptoms are not directly related to the observed haemodynamic disorders [3,5,7,20,35].”
From Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management (2019) · cites this paper as [20]
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Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management
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Einheitliche Basisversorgung von Kindern und Jugendlichen mit Long COVID
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Orthostatic intolerance in post-concussion patients
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Orthostatic Intolerance in Children With Long COVID Utilizing a 10-Minute Passive Standing Test
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Self-citationFamily history of associated disorders in patients with postural tachycardia syndrome
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Missed or Delayed Diagnosis of Heart Disease by the General Pediatrician
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Children With PANS May Manifest POTS
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Management of orthostatic intolerance in children: the state of the art
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High‐dose bilastine for the treatment of BASCULE syndrome
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Can pediatric vasovagal syncope be individually managed?
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Postural orthostatic tachycardia syndrome: A respiratory disorder?
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Considerations in Children and Adolescents Related to Coronavirus Disease 2019 (COVID-19)
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Self-citationRisk Factors for Orthostatic Hypertension in Children
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Assessment of comorbid symptoms in pediatric autonomic dysfunction
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Self-citationUnderstanding and Managing Adolescents with Conversion and Functional Disorders
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Self-citationDietary sodium and health: How much is too much for those with orthostatic disorders?
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Predictor of Syncopal Recurrence in Children With Vasovagal Syncope Treated With Metoprolol
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Creating a data dictionary for pediatric autonomic disorders
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Neurocognitive Difficulties Among Youth with POTS within an Intensive Pain Rehabilitation Program
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Self-citationEffect of Oral Iron Administration on Mental State in Children With Low Serum Ferritin Concentration
Mikami, K., Okazawa, H., Kimoto, K., Akama, F., Onishi, Y., Takahashi, Y., Yamamoto, K., & Matsumoto, H. (2019) · Global Pediatric Health · doi:10.1177/2333794x19884816 · Cited by 8 · see citing works
Postural Orthostatic Tachycardia Syndrome Associated with COVID-19: A Narrative Review
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Prevalence of Orthostatic Autonomic Dysregulation in Pediatric Concussion
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Navigating Complexity in Postural Orthostatic Tachycardia Syndrome
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Prognostic Value of Biomarkers in Children and Adolescents With Orthostatic Intolerance
Yan, H., Wang, S., Cai, H., Zhang, J., Liu, P., Wang, Y., Zou, R., & Wang, C. (2021) · Frontiers in Pediatrics · doi:10.3389/fped.2021.752123 · Cited by 7 · see citing works
The preponderance of initial orthostatic hypotension in postural tachycardia syndrome
Stewart, J. M., Kota, A. S., O’Donnell-Smith, M. B., Visintainer, P., Terilli, C., & Medow, M. S. (2020) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00540.2020 · Cited by 7 · see citing works
Self-citationFortunato, J. E., Laurienti, P. J., Wagoner, A. L., Shaltout, H. A., Diz, D. I., Silfer, J. L., & Burdette, J. H. (2021) · Neurogastroenterology & Motility · doi:10.1111/nmo.14271 · Cited by 6 · see citing works
Self-citationAutonomic Disturbances in Children with Nutcracker Syndrome: A Case Control Study
Dönmez, Y. N., Köksoy, A. Y., Bako, D., Giray, D., & Epçaçan, S. (2024) · Indian Pediatrics · doi:10.1007/s13312-024-3332-8 · Cited by 6 · see citing works
Sokol, O. E., Biggs, E. E., Berger, A. S., Simons, L. E., & Bhandari, R. P. (2025) · Children · doi:10.3390/children12020170 · Cited by 6 · see citing works
Autonomic Nervous System and Disorders of Gut–Brain Interaction
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Self-citationYuan, P., Lian, Z., Wang, Y., Wang, Y., Zhang, C., Du, J., Huang, Y., & Liao, Y. (2022) · Frontiers in Pediatrics · doi:10.3389/fped.2022.758100 · Cited by 7 · see citing works
Cheng, W., Wang, J., & Lin, J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19126974 · Cited by 6 · see citing works
Petracek, L. S., Eastin, E. F., Rowe, I. R., & Rowe, P. C. (2022) · BMC Sports Science Medicine and Rehabilitation · doi:10.1186/s13102-022-00529-8 · Cited by 6 · see citing works
Stewart, J. M., & Medow, M. S. (2023) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00016.2023 · Cited by 6 · see citing works
Self-citationSymptom Score: A New Instrument to Assess Orthostatic Intolerance in Children and Adolescents
Cai, H., Wang, S., Zou, R., Liu, P., Yang, H., Wang, Y., & Wang, C. (2020) · Journal of Child Neurology · doi:10.1177/0883073820936025 · Cited by 6 · see citing works
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Postural tachycardia syndrome (POTS) and antiphospholipid syndrome (APS): What do we know so far?
Noureldine, H., Hasbani, G. E., Eldine, M. N., Nour-Eldine, W., Taher, A., & Uthman, I. (2021) · Revue neurologique (Paris) · doi:10.1016/j.neurol.2021.10.006 · Cited by 5 · see citing works
Cyproheptadine Treatment in Children and Adolescents with Migraine: A Retrospective Study in Japan
Shimomura, H., Tokunaga, S., Terasaki, E., Taniguchi, N., Taniguchi, Y., Yoshitake, S., Terakita, Y., Inoue, K., Okuda, M., Kato, T., et al. (2024) · Neurology International · doi:10.3390/neurolint16060099 · Cited by 5 · see citing works
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Self-citationImpact of Comorbidities on the Prognosis of Pediatric Postural Tachycardia Syndrome
Wang, Y., Du, J., Li, X., Liu, P., Wang, Y., Liao, Y., & Jin, H. (2021) · International Journal of General Medicine · doi:10.2147/ijgm.s339805 · Cited by 6 · see citing works
- Authors
- Stewart, J. M., Boris, J. R., Chelimsky, G., Fischer, P. R., Fortunato, J. E., Grubb, B. P., Heyer, G. L., Jarjour, I. T., Medow, M. S., Numan, M. T., Pianosi, P. T., Singer, W., Tarbell, S., Chelimsky, T. C., & The Pediatric Writing Group of the American Autonomic Society
- Affiliations
- New York Medical College (US)
- Children's Hospital of Philadelphia (US)
- Medical College of Wisconsin (US)
- Mayo Clinic (US)
- Lurie Children's Hospital (US)
- University of Toledo Medical Center (US)
- Nationwide Children's Hospital (US)
- Texas Children's Hospital (US)
- University of Texas Houston, Houston, Texas; and
- Children's Hospital Colorado (US)
- ORCID
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2018-01-01
- Volume
- 141
- Issue
- 1
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- PMC
- PMC5744271
- OpenAlex
- W2771422290
- Cited by
- 222
- References
- 174
- Citations by year
- 2026: 26 · 2025: 27 · 2024: 23 · 2023: 24 · 2022: 38 · 2021: 25 · 2020: 33 · 2019: 12 · 2018: 13 · 2015: 1
- FWCI
- 3.36
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- PEDIATRICS (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Touro Scholar (Touro College) (submittedVersion)
- Funders
- U.S. Food and Drug Administration (R01 FD004789)
- Agency for Healthcare Research and Quality (HHSA 290 2015 00013I)
- National Heart, Lung, and Blood Institute (R01HL112736, R01HL134674, R01HL074873)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK083538)
- National Institute of Neurological Disorders and Stroke (R21NS094644, K23NS075141, R01NS092625)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Keywords
- orthostatic intolerance, orthostatic hypotension, vasovagal syncope, postural orthostatic tachycardia syndrome, neurogenic orthostatic hypotension, syncope, rapid weight loss, mast cell activation, central hypovolemia, joint hypermobility, anxiety, gastrointestinal symptoms, pediatric patients, diagnosis, treatment, prognosis
- MeSH terms
- Adolescent, Age Factors, Child, Postural Balance, Female, Humans, Hypotension, Orthostatic, Male, Pediatrics, Prognosis, Incidence, Risk Assessment, Tilt-Table Test, Syncope, Vasovagal, Orthostatic Intolerance, Postural Orthostatic Tachycardia Syndrome
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