Cited by 222Cardiovascular Syncope and Autonomic DisordersHeart Rate Variability and Autonomic ControlVestibular and auditory disorders

Pediatric Disorders of Orthostatic Intolerance

Open access
Stewart, Julian M., Boris, Jeffrey R., Chelimsky, Gisela, Fischer, Phillip R., Fortunato, John E., Grubb, Blair P., Heyer, Geoffrey L., Jarjour, Imad T. +7 more·2018·Pediatrics

Abstract

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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Crossref · 10.1542/peds.2017-1673

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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)
Venue
Pediatrics
Published
2018-01-01
Volume
141
Issue
1
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
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
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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