POTS in Teens: Postural Orthostatic Tachycardia Syndrome, Explained

Medically reviewed by Dr. Natalie Hernandez and Dr. Toni Kim

If your teenager gets dizzy every time they stand up, can't make it through a full day of school, and has been told their labs are "normal" more times than you can count, you already know something is wrong. You don't need another doctor to tell you it's stress.

POTS, or Postural Orthostatic Tachycardia Syndrome, is a real, physical condition, whether you're a parent looking for answers for your teen, or you're the one living with these symptoms yourself. It has diagnostic criteria, a physiological cause, and a genuine path toward feeling better.

What Is POTS?

POTS is a disorder of the autonomic nervous system, the part of the body that runs automatically in the background, adjusting heart rate, blood pressure, and blood flow every time you change position. In a teen with POTS, that system doesn't respond correctly when they stand up. Blood pools in the legs instead of circulating normally, so the heart compensates by racing.

The result is a heart rate that spikes with standing, even though the heart itself is structurally healthy. POTS often starts after puberty, a viral illness, a concussion, or a stretch of being sick or inactive, with symptoms most commonly beginning around age 14.

Symptoms of POTS in Teens

POTS symptoms fall into two groups.

Triggered by standing:

• Lightheadedness or feeling faint
• Racing heart or noticeable palpitations
• Shakiness or visible tremor
• Blurred vision
• Chest discomfort or shortness of breath
• Fainting or near-fainting

Present most of the time:

• Fatigue that doesn't improve with rest
• Brain fog and trouble concentrating
• Headaches or migraines
• Poor sleep
• Nausea, bloating, or stomach pain
• Tingling in the hands or feet

Heat, dehydration, standing for long periods, large meals, and, for teen girls, the days before a period tend to make symptoms worse. It's common for a teen with POTS to be dealing with ten or more of these symptoms at once, and for that combination alone to be enough to keep them out of school or off a sports team.

How Is POTS Diagnosed?

POTS is diagnosed by measuring what happens to a teen's heart rate when they move from lying down to standing. In adolescents, a sustained increase of 40 beats per minute or more within ten minutes of standing, without a significant drop in blood pressure, combined with several months of orthostatic symptoms, points to POTS.

This can often be established with a bedside test: heart rate and blood pressure checked while lying down, then again at 1, 3, 5, and 10 minutes after standing. When the picture isn't clear-cut, a tilt-table test provides confirmation.

Just as important is ruling out the conditions that can mimic POTS, dehydration, anemia, thyroid dysfunction, and a handful of others. That's a big part of why thorough testing matters before landing on a diagnosis: a fast label without ruling out what else could be going on isn't a complete answer.

The LIFE Integrative Approach to POTS

A single medication rarely resolves POTS on its own, and much of what actually helps; nutrition, sleep, activity, daily routines is exactly what a rushed visit has no time to address. At LIFE, those pieces aren't an afterthought. Dr. Hernandez builds a plan around the full picture, starting with the foundation that has the strongest evidence behind it, then layering in what each individual teen and family actually wants and needs.

Volume and salt. Most teens with POTS need more fluid and more sodium than they'd guess, often 2 to 3 liters of fluid and several grams of extra salt a day. This alone measurably improves symptoms for many patients.

Compression. Waist-high or thigh-high compression garments help keep blood from pooling in the legs.

Graduated exercise. This is the single most evidence-backed long-term treatment for POTS, and also the hardest to stick with, because it often starts with a teen who feels worse with any exertion. Reconditioning begins lying down or recumbent, a recumbent bike, rowing, swimming, and slowly builds toward upright activity over months, not weeks. It works, but it takes real coaching and patience to get a discouraged teen through the early stretch.

Comprehensive testing. Because Dr. Hernandez is a pediatric endocrinologist, your teen's workup doesn't stop at the tilt table. She looks at thyroid function, adrenal health, iron, vitamin D, and the broader metabolic picture, because POTS rarely shows up in isolation, and finding a second contributing piece often changes the plan.

Medication, when it's needed. For teens who need more than the foundation provides, there are several medication options that can be layered in, chosen based on which symptoms are most disruptive.

Low-dose naltrexone (LDN). Used off-label, LDN has become part of the toolkit for teens with significant inflammatory or autonomic symptom overlap. It's not for every patient, but many of our POTS patients see meaningful improvement with it as part of a broader plan.

Whole-person support. POTS affects school, sports, friendships, and sleep. Coordination with your teen's school, and referral for counseling or cognitive behavioral therapy when it would help, is part of the plan, not an afterthought.

Frequently Asked Questions (FAQ)

Why do doctors keep telling me it's just anxiety? Because POTS symptoms — a racing heart, dizziness, brain fog — overlap heavily with anxiety symptoms, and diagnosing POTS requires a specific test (tracking heart rate from lying down to standing) that a lot of visits simply don't include. That's a gap in how it gets caught, not a sign that what you're feeling isn't real.

Is POTS just anxiety? No. POTS is a measurable, physical change in heart rate tied to standing, documented with objective testing. Anxiety can look similar and can coexist with POTS, but one does not explain the other away.

Will my teen outgrow POTS? Many adolescents see real improvement by late adolescence or early adulthood, especially with consistent treatment. It's not universal, but the outlook for most teens is genuinely hopeful.

Do you need a tilt-table test to diagnose POTS? Not always. Bedside orthostatic vitals, checked lying down and then at intervals after standing, are enough to diagnose POTS in many patients. A tilt-table test is most useful when the bedside findings are borderline.

Is POTS the same as being out of shape? No, though the two can look similar and can feed each other — deconditioning can worsen POTS symptoms, and POTS can make it hard to stay active. Distinguishing the two matters, because the treatment (careful, graded reconditioning) looks different from simply "getting back in shape."

Does POTS mean something is wrong with my child's heart? No. The heart itself is structurally normal in POTS. The issue is with how the nervous system regulates blood flow and heart rate, not with the heart as an organ.

What's the difference between POTS and dysautonomia? Dysautonomia is the broader category — any dysfunction of the autonomic nervous system. POTS is the most common form seen in teens, but not the only one.

Can boys get POTS? Yes. POTS is more common in girls and women, but it does occur in boys, and it's diagnosed the same way regardless of sex.

Related Reading

• MCAS in Teens: Symptoms, Diagnosis & Treatment
• Why Does My Teen Have Both POTS and MCAS?

About Dr. Natalie Hernandez

Dr. Natalie Hernandez is a pediatric endocrinologist at LIFE Pediatric Endocrinology and the practice's lead physician for metabolic and obesity medicine, insulin resistance, PCOS/PMOS, pediatric weight, and the hormonal side of adolescence. She trained at Duke University Hospital, where her research on the metabolic signatures behind insulin resistance and youth-onset type 2 diabetes was published in the Journal of Clinical Endocrinology & Metabolism and recognized nationally. POTS falls squarely within that lens: the autonomic and metabolic systems are closely linked, which is why families bring her their teen's full symptom picture rather than a single, isolated complaint. She is a pediatric endocrinologist and board certified in pediatrics, and sees patients in English and Spanish. Above all, she starts every visit by listening to the full story, not just the chart.

Ready to Get Real Answers?

LIFE Pediatric Endocrinology is a concierge practice built for exactly this kind of complex, easy-to-dismiss case: longer visits, direct physician access, and testing that goes deep enough to find what's actually going on. Dr. Hernandez sees patients in Austin, Houston, and Dallas; Atlanta; Nashville; Miami; Beverly Hills, Los Angeles, Newport Beach, and Atherton, and by telemedicine nationwide.

Schedule a consultation with Dr. Hernandez to start with a full evaluation, not a guess.

Sources

• Sheldon RS, Grubb BP, Olshansky B, et al. 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope. Heart Rhythm, 2015.
• Bryarly M, Phillips LT, Fu Q, Vernino S, Levine BD. Postural Orthostatic Tachycardia Syndrome: JACC Focus Seminar. Journal of the American College of Cardiology, 2019.
• Robbins NM, Golden EP, Freeman KC, et al. Approach to Postural Orthostatic Tachycardia Syndrome. Neurology: Clinical Practice, 2026.
• Owens MR, Kaur D. The neuromuscular evaluation of postural orthostatic tachycardia syndrome. Muscle & Nerve, 2023.

Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Reading it does not create a physician-patient relationship with LIFE Pediatric Endocrinology or Dr. Hernandez. Always consult a qualified physician about your or your child's specific symptoms and medical history. If your teen experiences fainting, chest pain, or a severe allergic reaction, seek in-person or emergency medical care immediately.