💓 Always Tired, Always Dizzy?
Understanding POTS in children and teenagers
It’s a story I hear more often than people realise.
A teenager comes into clinic, usually with a parent who looks equally worried.
“She’s always tired.”
“He feels dizzy when he stands up.”
“She says her heart is racing.”
They’ve often seen a few doctors already. Blood tests are normal. ECG is normal. Sometimes they’ve even been told:
“Everything looks fine.”
And yet — something clearly isn’t.
One possibility we sometimes explore in these situations is a condition called POTS.
What is POTS?
POTS (Postural Orthostatic Tachycardia Syndrome) is a condition that affects how the body regulates heart rate and blood flow when moving from lying or sitting to standing.
When we stand up, gravity pulls blood downwards. Normally, the body compensates quickly.
In children with POTS, this adjustment doesn’t work as smoothly.
The heart rate increases significantly — often by 30–40 beats per minute or more — just to maintain blood flow to the brain.
That’s when symptoms begin.
What symptoms might you notice?
POTS can look different in each child, which is why it is sometimes missed.
Common symptoms include:
💫 Dizziness and lightheadedness
- Especially when standing up
- Sometimes associated with near-fainting
❤️ Palpitations
- Awareness of a fast or pounding heartbeat
😴 Fatigue
- Persistent tiredness, often out of proportion to activity
🧠 “Brain fog”
- Difficulty concentrating
- Feeling mentally slow or unfocused
🤢 Other symptoms
- Headaches
- Nausea
- Exercise intolerance
Some children also describe simply “not feeling right” — a vague but very real experience.
Who does it affect?
POTS is more commonly seen in:
- Teenagers and adolescents
- Girls more than boys
- Children following a viral illness
- Those going through rapid growth or hormonal changes
It is not rare — but it is often under-recognised.
Why does it matter?
POTS is not life-threatening.
But it can be life-disrupting.
School attendance may drop. Sports become difficult. Social life is affected. Confidence takes a hit — especially when symptoms are not clearly understood.
Perhaps the hardest part for families is this:
Everything looks normal on paper.
How is POTS diagnosed?
Diagnosis starts with listening carefully to the story.
We then look at:
- Heart rate and blood pressure changes from lying to standing
- Symptom patterns
- Excluding other possible causes
Sometimes further tests are needed, but often a detailed clinical assessment gives us the answer.
What can be done?
The encouraging news is that there are ways to help.
Management may include:
- Increasing fluid and salt intake
- Gradual physical reconditioning
- Sleep and lifestyle optimisation
- In some cases, medication
Treatment is always tailored to the individual child.
And importantly — many young people improve over time.
When should you consider seeking help?
If your child or teenager has:
- Frequent dizziness on standing
- Ongoing fatigue affecting daily life
- Recurrent palpitations
- Difficulty keeping up with school or activities
Or if you simply feel something isn’t adding up…
It is worth having a proper assessment.
A final thought
One of the most important things I often say to families is this:
Just because tests are normal, it doesn’t mean symptoms aren’t real.
Children with POTS are not imagining it.
Their bodies are working harder than they should just to do everyday things.
And with the right support, things can get better.
🌿 About Dr Rachel
I am a consultant paediatrician based in Liverpool and the Northwest UK, with over 15 years of experience in caring for children with complex and often subtle conditions.
I take time to listen, look at the whole picture, and help families make sense of symptoms that don’t always fit neatly into a box.