🌿 Postural Orthostatic Tachycardia Syndrome (POTS) and Our Clinic's Treatment Policy

We will guide you through our approach to medical treatment and our treatment policies.
Patients, please read this in advance.

What is Orthostatic Dysregulation Disorder?

Orthostatic dysregulation (OD) is a condition where the body is unable to properly regulate blood pressure and heart rate upon standing, leading to various physical symptoms.
It is commonly seen in children from late elementary school to adolescence. Reports indicate that it is seen in approximately one in five boys and one in four girls in high school, so it is not a rare condition.

Common symptoms

I have trouble waking up in the morning.
Dizziness, vertigo
Headache, abdominal pain, nausea
Palpitations, shortness of breath
Easily tired, sluggish
My head feels fuzzy.
Cannot stand for long periods of time
I feel unwell in the morning but get better in the afternoon.

Symptoms may worsen when standing and may improve when sitting or lying down.
Not being able to wake up in the morning or go to school may not just be a matter of laziness or mood.

Consider seeking medical attention

This is when symptoms continue and affect your daily life as follows:

🔸 Tardiness and absences are increasing
School life and participation in club activities are becoming difficult.
Outdoor activities and daytime excursions are decreasing.
It's difficult to handle on your own or with just your family.

Even with symptoms similar to OD, other illnesses such as anemia, thyroid disease, or heart disease may be underlying.

Our Treatment Policy

In orthostatic intolerance, various factors can be intertwined, not only physical symptoms but also sleep disturbances, irregular daily rhythms, decreased physical stamina, and challenges with school life.
At our hospital, we confirm the necessary progress and background, but instead of spending a long time just looking for the cause,We will proceed with treatment by focusing on "what can be done now."
How to regulate your daily routine
Where to start your daytime activities
How to review your hydration and diet
How to stay connected with the school

We will work together to think about specific things you can do, based on your child's current condition.
Rather than relying on medication, I prioritize gradually adjusting my lifestyle to regain the ability to be active during the day.
Regarding specific lifestyle adjustments and exercise recommendations, I will explain them in detail during your visit.
The revised 3rd edition guidelines of the Japanese Society of Pediatric Psychosomatics also include sections on non-pharmacological therapy, exercise therapy, and fluid/salt intake.

Here's the flow of medical treatment at our clinic:
For your first and second appointments, please book within the "Consultation/Specialty Clinic" appointment slot.

If you visit outside of the reserved time slot, or depending on the staff availability and the clinic's congestion on the day, blood collection and standing tests may not be performed on the same day and may be scheduled for a later date. We appreciate your understanding.

First time
I will check the progress of your symptoms. We will perform an examination and blood tests.
We will check for any other illnesses, symptoms that require early examination, or referral to a specialist.
Second time
We will check in detail about sleep, diet, fluid intake, daytime activities, exercise, and school life.
In addition to that, we will discuss lifestyle adjustments tailored to your child's condition and future treatment plans.
3rd time and beyond
We will confirm your symptoms and changes in your lifestyle based on a simple consultation and records, and adjust your treatment as necessary.

About medicine

If necessary, we may use medications to alleviate symptoms of orthostatic intolerance, traditional Chinese medicine, or melatonin.
We do not prescribe psychotropic drugs or general sleeping pills.
If specialized treatment for mental symptoms is considered necessary, we will guide you to consult a psychiatrist or child psychiatrist.

Regarding the progress

The course of postural orthostatic tachycardia syndrome varies from person to person.
While some children improve in a relatively short period, if the symptoms are severe, or if they are accompanied by school refusal or long-term absence, it may take several years to see improvement.
Many children find their symptoms improve as they grow, making it easier to live their daily lives by the time they graduate from high school, but the timing of recovery varies from person to person.
Instead of aiming to immediately return to our former lives, we will gradually build upon what we can do now.

⚠️ If you experience psychiatric symptoms

If the main symptoms are suspected mental illness, such as auditory hallucinations or strong feelings of persecution, please consult a psychiatrist or child psychiatrist instead of our O.D. clinic.
If you have thoughts of harming yourself or wish to die, or if it is difficult to ensure your own or others' safety, please seek immediate consultation with a psychiatrist or an emergency medical facility, without waiting for a regular appointment.

📚 References

🔸 Japanese Society of Pediatric Psychosomatics, ed. *Pediatric Psychosomatics Society Guideline Collection, Revised 3rd Edition: 7 Guidelines for Everyday Practice*. Nanzando, 2025.
🔸 Boris Jr, Moak JP. Pediatric Postural Orthostatic Tachycardia Syndrome: Where We Stand. Pediatrics. 2022;150(1):e2021054945.
🔸 Vernino S, et al. Postural Orthostatic Tachycardia Syndrome (POTS): State of the Science and Clinical Care from a 2019 National Institutes of Health Expert Consensus Meeting—Part 1. Auton Neurosci. 2021;235:102828.
🔸 Huynh P, et al. Management of Postural Orthostatic Tachycardia Syndrome in Pediatric Patients: A Clinical Review. J Pediatr Pharmacol Ther. 2024;29(5).
🔸 Hebson C, Harberg M, Borasino P. Pediatric Orthostatic Intolerance—A Review With Focus on Recent Research. Curr Opin Pediatr. 2025.

After your visit to our clinic, please review the relevant pages listed below.
Orthostatic Intolerance (OD): Lifestyle modifications for sleep, hydration, exercise, and school life (Password-protected)
Recumbent Bike Exercise Therapy for Orthostatic Dysregulation (OD) (Password-protected)
Selecting Swimming and Aquatic Walking as Exercise Therapy for Orthostatic Dysregulation (OD)(Password-protected)
Comprehensive Exercise Program for Orthostatic Dysregulation (OD)(Password-protected)