What Is POTS? And Why Are So Many Kids Told It’s “Just Anxiety”?

Dizziness. Brain fog. A racing heart when standing. Crushing fatigue.

I see these symptoms all the time. And too often, kids are told their labs are normal and it must be anxiety.

Sometimes it is anxiety. But sometimes it’s POTS.

POTS stands for Postural Orthostatic Tachycardia Syndrome. It’s a problem with the autonomic nervous system — the part of your body that controls things you don’t think about, like heart rate and blood flow.

Why Does Your Heart Race?

In people with POTS, when they stand up, gravity pulls blood down into their legs and belly. Normally, your nervous system tightens blood vessels and keeps blood moving back up to your brain. In POTS, that system doesn’t adjust well. Blood pools in the lower body. The brain senses less blood flow and sends out an alarm.

The problem is that a fast heart doesn’t always pump better. If the heart beats too quickly, it doesn’t have time to fill with blood between beats. Less blood gets to the brain. And that’s when kids feel dizzy, foggy, shaky, or wiped out.

What Causes POTS?

We’ve learned that POTS often shows up after a viral infection. COVID made this easier to see, but it’s not the only virus involved. The infection seems to act like a trigger in kids who are already vulnerable. The immune system stays revved up and the autonomic system doesn’t reset properly.

The good news? There are treatments.

Treatment often starts with simple things: more fluids, more salt, compression garments, and a specific exercise program that retrains the nervous system. Some kids benefit from medications that slow the heart rate or support blood flow. Care is individualized. We target the worst symptoms first.

The most important thing to know is this isn’t a made-up condition. And it isn’t rare.

For a long time, these kids were dismissed. Now we’re starting to understand what’s happening.

If your child has confusing symptoms and normal tests, it might be worth asking about POTS. Listen to the full podcast episode to hear details about treatment!

Find Help with my expert guest Pediatric Autonomic Specialist: Jeffrey Boris, MD.