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.
When a child with OI stands, blood pools in the lower body, causing symptoms like:
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.
These symptoms can make it hard for children to participate in school, sports, or social activities, often leaving them feeling isolated and misunderstood.
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.
There are several strategies that can help children manage OI and POTS symptoms. While every child is different, these approaches may provide relief.
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.
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.
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.
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 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.
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) 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.
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 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.
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.
Here are some common medications for POTS:
| Medication | How It Works | Possible Side Effects |
|---|---|---|
| Ivabradine | Slows the heart rate | Fatigue, flashing lights (phosphenes) |
| Metoprolol | Reduces heart rate spikes | Dizziness, fatigue |
| Midodrine | Increases blood pressure | Tingling scalp, goosebumps |
| Fludrocortisone | Helps the body keep salt and water | High blood pressure, low potassium |
Your child’s doctor will decide if medication is appropriate.
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.
Look for a pediatric autonomic specialist or a clinic that understands Long COVID in children.
Long COVID Families is a U.S.-based organization that supports families navigating Long COVID in children. They offer resources, advocacy, and a community of parents who understand what you’re going through.
Visit www.longcovidfamilies.org for more information, resources, and support.
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.