Why Your Child Feels Dizzy and Tired: Understanding Long COVID & POTS

If your child is still struggling with fatigue, dizziness, or brain fog months after a COVID infection, they might be dealing with Orthostatic Intolerance (OI) or Postural Orthostatic Tachycardia Syndrome (POTS). These conditions affect how the body regulates blood flow and can cause a wide range of symptoms that impact daily life.

OI and POTS are increasingly recognized in children with Long COVID, but many families are unaware of these conditions and how to manage them. Let’s break down what parents need to know.

What Are Orthostatic Intolerance (OI) and POTS?

• • Dizziness
  • Lightheadedness
  • Rapid heartbeat (tachycardia)
  • Nausea
  • Fainting or near-fainting episodes

A more specific form of Orthostatic Intolerance (OI) is Postural Orthostatic Tachycardia Syndrome (POTS). Children with POTS experience a significant increase in heart rate — often more than 40 beats per minute — within minutes of standing.

Symptoms of POTS in Children

• • Severe fatigue
  • Lightheadedness or dizziness
  • Heart palpitations (racing or pounding heartbeat)
  • Nausea
  • Brain fog or difficulty concentrating
  • Fainting

These symptoms can make it hard for children to participate in school, sports, or social activities, often leaving them feeling isolated and misunderstood.

Why Are OI and POTS Linked to Long COVID?

Research shows that up to 71% of children with Long COVID experience some form of Orthostatic Intolerance (OI). But why does this happen?

Experts believe the COVID-19 virus may damage the autonomic nervous system, which controls functions like heart rate, blood pressure, and blood flow. This damage can make it difficult for the body to manage blood flow when standing, causing dizziness and fatigue.

Another theory is that inflammation and immune system dysfunction triggered by COVID-19 may contribute to these symptoms. Regardless of the cause, OI and POTS are becoming increasingly recognized as post-viral complications in children.

How Can Parents Help Kids Manage OI and POTS?

There are several strategies that can help children manage OI and POTS symptoms. While every child is different, these approaches may provide relief.

1. Increase Hydration and Salt Intake

Encourage your child to drink more fluids throughout the day and increase salt intake (with your doctor’s approval). Staying hydrated can help boost blood volume, making it easier for the body to regulate blood flow.

💡 Tip: Electrolyte drinks can be helpful, but plain water with a pinch of salt works too.

2. Use Compression Garments

Compression socks or abdominal binders can help reduce blood pooling in the legs and lower body. This can prevent dizziness and fainting by improving blood flow to the brain. 

3. Low-Impact Activities and Movement

Traditional exercise can be difficult for children with POTS and Long COVID, especially those who experience exercise intolerance or post-exertional malaise (PEM). However, some low-impact activities may help improve blood flow and reduce symptoms without triggering a crash.

Activities to consider include:

• • Swimming (a great option because the body is supported by water)
  • Recumbent cycling (where your child remains seated)
  • Stretching or gentle yoga

4. Understanding Your Child’s Limits: Exercise Intolerance and Post-Exertional Malaise (PEM)

Children with Long COVID often experience exercise intolerance and post-exertional malaise (PEM), both of which can significantly impact their ability to participate in daily activities. Recognizing these conditions can help parents better support their child's recovery.

Exercise Intolerance

Exercise intolerance means that a child’s body struggles to tolerate physical activity, even at low levels. During activity, the body may have difficulty regulating heart rate, blood flow, and energy use, causing symptoms to appear immediately or shortly after exertion.

Signs of Exercise Intolerance:

• • Feeling dizzy or lightheaded during activity
  • Heart palpitations or a racing heart
  • Shortness of breath or chest discomfort
  • Fatigue that sets in quickly during activity
  • Muscle weakness or aches

Everyday tasks such as walking, climbing stairs, or even getting dressed can feel exhausting for some children with Long COVID. These symptoms may improve with rest, but they can return quickly when the child tries to be active again.

💡 Tip: Pay attention to how your child feels during and immediately after activity. If they seem unusually tired or unwell, they may need more rest.

Post-Exertional Malaise (PEM)

Post-exertional malaise (PEM) is a delayed worsening of symptoms that occurs after physical, mental, or emotional exertion. Unlike exercise intolerance, which happens during activity, PEM can appear hours or even days later and last for days or weeks.

Symptoms of PEM can include:

• • Extreme fatigue that doesn’t improve with rest
  • Worsening dizziness or heart palpitations
  • Increased brain fog or difficulty concentrating
  • Nausea, headaches, or muscle pain
  • Flu-like symptoms, such as body aches and chills

Even everyday activities — like doing homework, talking with friends, or walking to the mailbox — can trigger PEM. Once PEM sets in, it can take significant rest and recovery time to improve.

💡 Tip: Keep an activity log to track patterns and recognize triggers that may lead to PEM. This can help identify activities that should be limited or adjusted to avoid flares.

PEM and ME/CFS

PEM is the cardinal symptom of ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome), a condition that is often associated with Long COVID. Understanding PEM is essential to supporting children with Long COVID effectively.

How to Support Your Child

To help manage exercise intolerance and PEM, parents can follow a pacing approach. Pacing involves balancing activity with rest to prevent overexertion and minimize symptom flare-ups.

For more guidance on pacing, managing PEM, and other helpful resources, check out our Pacing Guide.

What About Medications?

Here are some medications that may be prescribed for children with POTS:

Here are some common medications for POTS:

Your child’s doctor will decide if medication is appropriate.

When to See a Specialist

If your child experiences persistent symptoms like dizziness, fatigue, or fainting when standing, it’s important to consult a healthcare provider. These symptoms are not something your child can "push through" — they are physical and require medical attention. 

You’re Not Alone

Key Takeaways

• • Orthostatic Intolerance (OI) and Postural Orthostatic Tachycardia Syndrome (POTS) are conditions that affect blood flow and are common in kids with Long COVID.
  • Symptoms include dizziness, rapid heart rate, fatigue, and brain fog.
  • Many children with Long COVID also experience exercise intolerance and post-exertional malaise (PEM), so families should use pacing to manage activity levels.
  • Medications and lifestyle changes like hydration, compression garments, and low-impact activities may help manage symptoms.

Medical Disclaimer

This blog is for informational purposes only and is not a substitute for medical advice. Always consult a healthcare provider before making any changes to your child’s treatment plan.

Citations

1. Kennedy Krieger Institute, “Study on Orthostatic Intolerance in Pediatric Long COVID”
2. Chun-Yan Tao et al., Management of Pediatric Orthostatic Intolerance and POTS
3. Huynh P., Clinical Review on Pediatric POTS Treatments
4. Institute of Medicine (IOM), Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness
5. Davis, H. et al., Characterizing Long COVID in Children: A Pediatric Review on Post-Viral Symptoms, PEM, and Exercise Intolerance, 2021