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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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“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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Metadata
- 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
- 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 › Cardiology and Cardiovascular Medicine › 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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