Distinguishing between orthostatic intolerance, POTS, and vasovagal syncope in children

Symptoms of dizziness, lightheadedness, syncope, nausea, fatigue, and headaches are quite common in children and adolescents. Pediatricians often face the challenge of using symptoms and more objective findings together to categorize patients. Although some believe this group of symptoms represents a spectrum of disease, there appears to be important differences in both pathophysiology and clinical presentation. Another issue has been the use of adult criteria for heart rate changes during tilt table testing. This may be problematic because of the normal age-related changes seen in heart rate (HR) and HR response throughout the pediatric age range.