Pediatric disorders of orthostatic intolerance

The Pediatric Writing Group of the American Autonomic Society

Research output: Contribution to journalReview articlepeer-review

45 Scopus citations

Abstract

Orthostatic intolerance (OI), having difficulty tolerating an upright posture because of symptoms or signs that abate when returned to supine, is common in pediatrics. For example, ∼40% of people faint during their lives, half of whom faint during adolescence, and the peak age for first faint is 15 years. Because of this, we describe the most common forms of OI in pediatrics and distinguish between chronic and acute OI. These common forms of OI include initial orthostatic hypotension (which is a frequently seen benign condition in youngsters), true orthostatic hypotension (both neurogenic and nonneurogenic), vasovagal syncope, and postural tachycardia syndrome. We also describe the influences of chronic bed rest and rapid weight loss as aggravating factors and causes of OI. Presenting signs and symptoms are discussed as well as patient evaluation and testing modalities. Putative causes of OI, such as gravitational and exercise deconditioning, immune-mediated disease, mast cell activation, and central hypovolemia, are described as well as frequent comorbidities, such as joint hypermobility, anxiety, and gastrointestinal issues. The medical management of OI is considered, which includes both nonpharmacologic and pharmacologic approaches. Finally, we discuss the prognosis and long-term implications of OI and indicate future directions for research and patient

Original languageEnglish (US)
Article numbere20171673
JournalPediatrics
Volume141
Issue number1
DOIs
StatePublished - Jan 2018

Bibliographical note

Funding Information:
R01 NS092625, K23 NS075141, and FD004789 [Food and Drug Administration]); the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK083538); Advancing a Healthier Wisconsin (grant 5520298); the Huseby family; the Hohmann Foundation; the US Department of Health and Human Services (HHSA290201500013I); Medtronic; and H. Lundbeck A/S. Funded by the National Institutes of Health (NIH).

Funding Information:
Supported by the National Heart, Lung, and Blood Institute (R01HL112736); the National Institute of Neurological Disorders and Stroke (R21NS094644, R01 NS092625, K23 NS075141, and FD004789 [Food and Drug Administration]); the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK083538); Advancing a Healthier Wisconsin (grant 5520298); the Huseby family; the Hohmann Foundation; the US Department of Health and Human Services (HHSA290201500013I); Medtronic; and H. Lundbeck A/S. Funded by the National Institutes of Health (NIH).

Funding Information:
fUnding: Supported by the National Heart, Lung, and Blood Institute (R01HL112736); the National Institute of Neurological Disorders and Stroke (R21NS094644,

Publisher Copyright:
Copyright © 2018 by the American Academy of Pediatrics. All rights reserved.

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