Learning About Postural Orthostatic Tachycardia Syndrome (POTS) in Children

Postural orthostatic tachycardia syndrome (say "PAWS-chur-uhl or-tho-STAT-ik tack-ee-KAR-dee-uh”), or POTS, makes your child’s heart pump too fast for too long after they stand up. It can make your child feel dizzy, sweaty, tired, and sick.

Experts don't fully understand what causes POTS. It seems to involve problems with how the body controls heart rate, blood flow, and blood volume when your child stands up. The nervous system, the blood vessels, and the amount of blood in the body may all play a role. It may follow certain triggers such as a viral illness, a concussion, an injury, or a surgery.

Normally when a child stands up, the nervous system sends signals, and some hormones react. The heart beats a bit faster, and the blood vessels in the lower body get smaller. This helps make sure that enough blood can be pumped up to the brain. The heart rate goes back to normal after a minute or two.

But with POTS, this process doesn't work as it should. The body doesn't control the heart rate correctly after your child stands up. The heart rate stays too high for as long as your child remains standing. It usually improves when your child sits or lies back down.

Soon after standing up, your child may have symptoms such as:

• A fast, pounding heartbeat (palpitations).
• Trembling, dizziness, weakness, or lightheadedness.
• Feeling faint or very tired.

Your child may also have:

• Blurred vision, headaches, nausea, and diarrhea.
• Trouble sleeping, and they may feel anxious.
• Problems with keeping their attention focused.

Some things can make symptoms worse. These include heat, the menstrual cycle, dehydration, exercise, and standing for a long time.

Your doctor may ask about your child’s health history and symptoms, including when and how the symptoms started. The doctor may check how blood pressure and heart rate change when your child moves from lying down to standing. The doctor may do a 10-minute standing test while watching for changes in your child's heart rate. The doctor may do a tilt table test. Your child lies on a table that can be tilted from a horizontal to vertical position. Your child's heart rate and blood pressure are watched as your child's position changes.

Other tests may include:

• Electrocardiogram (EKG). This checks the heart's electrical function.
• Blood and urine tests. Your child may be checked for other problems that cause symptoms like POTS.
• Echocardiogram. This test looks at your child’s heart's function as the heart beats.
• Exercise test. This measures your child’s heart rate and blood pressure during exercise.
• QSART. This tests the nerves that control sweating.
• Skin nerve biopsy. Small samples of skin are taken. The doctor looks at the small nerves in your child’s skin.

There is no known way to cure POTS. Work with your child’s doctor to find the right mix of treatments to help relieve symptoms and improve your child’s quality of life. Treatment may include:

• Drinking more fluids.
• Eating more salt.
• Taking part in a structured exercise program.
• Wearing compression garments.
• Avoiding triggers, such as heat, that can make symptoms worse.
• Taking medicine prescribed by your doctor. For some children, taking medicine that increases blood pressure can help. Medicine that lowers the heart rate or keeps the body's fluids balanced may also help.

Call 911 anytime you think your child may need emergency care. For example, call if:

• Your child passed out (lost consciousness) and it feels different from your child’s usual episode, or they don't recover as quickly as they have in the past.

Contact your doctor now or seek immediate medical care if:

• The symptoms are getting worse. For example, your child is more dizzy or lightheaded.

Watch closely for changes in your child’s health, and be sure to contact your doctor if:

• Your child's symptoms don't improve as expected.