Pediatric orthostatic intolerance - a review with focus on recent research

To provide pediatric providers with the most up to date information on evaluation, diagnosis, and treatment of orthostatic intolerance and postural orthostatic tachycardia syndrome (POTS). In this review, new research is summarized on the importance of exercise, the role of anxiety and depressed mood in exacerbating symptoms, and medication utilization. Orthostatic intolerance and POTS are increasingly common causes of significant infirmity during adolescence. Pediatricians are front line in implementing treatment, which is centered on patient education and nonpharmacologic strategies. Precise history taking identifies the conditions, and accurately explaining the pathophysiology to families encourages patient buy-in to follow a rigorous treatment program. While anxiety and depressed mood are not central causes of symptomatology, they do exacerbate a patient's presentation and thus must be treated aptly. Prognosis is excellent in patients who adhere to a treatment plan, and encouragement from providers as to this expectation is key to building a strong therapeutic alliance.