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

Is your child still feeling tired, dizzy, or foggy-headed months after having COVID-19? They might be dealing with a condition tied to dysautonomia, a disorder of the autonomic nervous system. Dysautonomia can cause a range of symptoms, including Orthostatic Intolerance (OI) and Postural Orthostatic Tachycardia Syndrome (POTS)—conditions that make it harder for the body to regulate blood flow and maintain balance, especially when standing.

These symptoms can significantly disrupt daily life, but they’re often misunderstood or overlooked. As doctors uncover more about how dysautonomia, OI, and POTS impact kids with Long COVID, many families remain unaware of these conditions and how to address them. Let’s explore what every parent should know to better support their child.

What Are Orthostatic Intolerance (OI) and POTS?

Orthostatic Intolerance (OI) happens when the body has trouble controlling blood flow and blood pressure when standing up. Normally, the nervous system makes sure blood keeps flowing to the brain, but in kids with OI, this doesn’t work right. Blood collects in the lower body, which can cause symptoms like:

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

Postural Orthostatic Tachycardia Syndrome (POTS) is a type of OI. It is diagnosed when a child’s heart rate goes up by 40 beats per minute or more within 10 minutes of standing, without their blood pressure dropping too much. The big jump in heart rate is what makes POTS different from other forms of OI.

Symptoms of POTS in kids include:

  • 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?

One study found 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 might damage the autonomic nervous system, making it harder for the body to regulate blood flow when standing. 

Another idea is that inflammation and problems with the immune system caused by COVID-19 might lead to these symptoms. No matter the cause, doctors are starting to see OI and POTS as common complications after a viral illness in children.

 

How Can Parents Help Kids Manage OI and POTS? 

If your child has Orthostatic Intolerance (OI) or Postural Orthostatic Tachycardia Syndrome (POTS), there are ways to help them feel better. Every child is different, but these strategies can make a big difference.

1. Drink More Fluids and Eat More Salt

helpful Getting enough water and salt can help the body manage blood flow better. This boosts blood volume and can reduce dizziness and fatigue. 

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

2. Use Compression Garments

Wearing compression socks or an abdominal binder can stop blood from pooling in the legs. This helps keep blood flowing to the brain, which can prevent dizziness or fainting.

3. Low-Impact Activities and Movement

Regular exercise can be tough for kids with POTS or Long COVID, but gentle movements can still help. Start with low-impact activities that won’t overwork their body. Working with a physical therapist knowledgeable about pediatric Long COVID and POTS can make a significant difference. They can create a tailored exercise program that gradually strengthens the cardiovascular system without overwhelming the body.

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

đź’ˇ Start small: Even short bursts of movement, like stretching for a few minutes or practicing gentle yoga poses, can be a good first step. These activities should always be guided by how your child feels, with plenty of rest breaks and no pressure to push through symptoms.

4. Understanding Your Child’s Limits

Many kids with Long COVID have exercise intolerance or post-exertional malaise (PEM). These conditions make it hard for their bodies to handle physical activity, even simple things like walking or climbing stairs.

Exercise Intolerance

Exercise intolerance means your child’s body has trouble with even small amounts of physical activity. During or after activity, they may feel: the body may have difficulty regulating heart rateblood 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 like getting dressed or walking can leave them feeling wiped out. These symptoms may get better with rest but can come back if your child tries to do too much too soon.

 đź’ˇ 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 Nauseaheadaches, or muscle pain
  • Flu-like symptoms, such as body aches and chills

Even simple tasks, like doing homework, chatting with friends, or walking to the mailbox, can bring on PEM. Once it starts, your child will need plenty of rest and time to recover.

đź’ˇ Tip: Keep an activity log to track patterns and recognize triggers that may lead to PEM. This can help identify activitiesthat 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.

PEM How Can Parents Help? 

The best way to manage PEM is to use a strategy called pacing. Pacing means balancing activity with rest to avoid overdoing it. This helps prevent symptom flare-ups and gives the body time to heal.

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

What About Medications?

 In some cases, doctors may recommend medications to help manage OI and POTS. These medications work by improving blood flow, controlling heart rate, and reducing dizziness.

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

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.

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. 

Look for a pediatric neurologist or cardiologist who specialize in dysautonomia or a clinic that understands Long COVID in children. For a community-recommended list of pediatric Long COVID providers, visit this link 

You’re Not Alone

Caring for a child with Long COVID can be exhausting and overwhelming, especially when symptoms like OI and POTS make everyday life more difficult. But you’re not alone.

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.

Key Takeaways

  • OI and POTS are conditions that affect blood flow and are common in kids with long COVID.
  • Symptoms include dizziness, a fast heartbeat, fatigue, and brain fog.
  • Many kids with long COVID also have exercise intolerance and post-exertional malaise (PEM), so pacing activities is important.
  • Medications and lifestyle changes like drinking more water, wearing compression garments, and doing low-impact activities can help manage symptoms.
  • With the right care and resources, your child can feel better over time.

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”

    1. Chun-Yan Tao et al., Management of Pediatric Orthostatic Intolerance and POTS

    1. Huynh P., Clinical Review on Pediatric POTS Treatments

    1. Institute of Medicine (IOM), Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness

    1. Davis, H. et al., Characterizing Long COVID in Children: A Pediatric Review on Post-Viral Symptoms, PEM, and Exercise Intolerance, 2021