Adolescent Fatigue, POTS, and Recovery: A Guide for Clinicians

• Published in: Current problems in pediatric and adolescent health care Vol. 44; no. 5; pp. 108 - 133
• Main Authors: Kizilbash, Sarah J., Ahrens, Shelley P., Bruce, Barbara K., Chelimsky, Gisela, Driscoll, Sherilyn W., Harbeck-Weber, Cynthia, Lloyd, Robin M., Mack, Kenneth J., Nelson, Dawn E., Ninis, Nelly, Pianosi, Paolo T., Stewart, Julian M., Weiss, Karen E., Fischer, Philip R.
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.05.2014
• Subjects: Adolescent; Autonomic Nervous System - physiopathology; Cognitive Behavioral Therapy; Dizziness - etiology; Dizziness - physiopathology; Exercise; Fatigue Syndrome, Chronic - physiopathology; Fatigue Syndrome, Chronic - rehabilitation; Fatigue Syndrome, Chronic - therapy; Female; Humans; Male; Orthostatic Intolerance - physiopathology; Orthostatic Intolerance - therapy; Pediatrics; Postural Orthostatic Tachycardia Syndrome - physiopathology; Postural Orthostatic Tachycardia Syndrome - rehabilitation; Postural Orthostatic Tachycardia Syndrome - therapy; Practice Guidelines as Topic; Risk Factors; Syncope - etiology; Syncope - physiopathology
• ISSN: 1538-5442; 1538-3199; 1538-3199
• DOI: 10.1016/j.cppeds.2013.12.014

Many teenagers who struggle with chronic fatigue have symptoms suggestive of autonomic dysfunction that may include lightheadedness, headaches, palpitations, nausea, and abdominal pain. Inadequate sleep habits and psychological conditions can contribute to fatigue, as can concurrent medical conditions. One type of autonomic dysfunction, postural orthostatic tachycardia syndrome, is increasingly being identified in adolescents with its constellation of fatigue, orthostatic intolerance, and excessive postural tachycardia (more than 40beats/min). A family-based approach to care with support from a multidisciplinary team can diagnose, treat, educate, and encourage patients. Full recovery is possible with multi-faceted treatment. The daily treatment plan should consist of increased fluid and salt intake, aerobic exercise, and regular sleep and meal schedules; some medications can be helpful. Psychological support is critical and often includes biobehavioral strategies and cognitive–behavioral therapy to help with symptom management. More intensive recovery plans can be implemented when necessary.