Most teens with POTS (postural orthostatic tachycardia syndrome) are treated with a combination of fluids, salt, compression, a gradual exercise plan, school accommodations and, when needed, medication. In a series of 708 patients at the Children's Hospital of Philadelphia (CHOP), symptoms started at a median age of 12.6 years in teens with joint hypermobility and 13.7 years in those without, and the median age at diagnosis was 15.7 (Boris and Bernadzikowski, 2018).
If your teen is 16 or older and the usual steps have not been enough, our 5-day program in Provo is summarized below.
POTS treatment for teens 16 and up
Is standard POTS care not enough for your teen?
Our 5-day POTS program in Provo, Utah, adds to the care your teen's own doctor already provides. Tell us about your teen, then talk it through with our team on a free video consult.
Book my free consult How the program works
Starts with our POTS intake form, which a parent can fill in with or for their teen. Then you pick a time for a 15 to 30 minute video call. Prefer to talk? Call (385) 375-8590.
Get medical care promptly if your teen faints and gets hurt, has chest pain during exercise, has a known heart condition, or develops new symptoms nobody has explained, and check with the doctor before starting any new exercise plan. Call 911 if your teen faints and does not wake up within a minute or two, has chest pain that does not ease with rest, has trouble breathing, or has sudden weakness, slurred speech or confusion. If your teen faints or nearly faints, ask their doctor whether it is safe to drive until episodes are under control.
POTS is a problem with how the body adjusts heart rate and blood flow when a person stands up. In a teen with POTS, the heart rate climbs sharply within minutes of standing, and symptoms follow: lightheadedness, a racing or pounding heart, fatigue, headaches, nausea, trouble concentrating and sometimes fainting. Symptoms usually ease when your teen lies down.
In the CHOP series, girls outnumbered boys about 3.5 to 1. More than half of the teens had joint hypermobility, and 22.4% had hypermobile Ehlers-Danlos syndrome. In about a quarter of cases, an infection was a possible trigger, and in 11.4% a concussion was (see POTS after a concussion). Most teens eventually reported many symptoms across several body systems, and half had at least 14 (Boris and Bernadzikowski, 2018).
A teen with POTS who is exhausted, foggy and missing school can be labeled anxious, unmotivated or depressed. Our guide on why POTS is so often misdiagnosed as anxiety covers how to push for the right testing. If you want to bring data to the appointment, our free POTS symptom tracker lets your teen log heart rate, symptoms and triggers.
The diagnostic bar is higher for teenagers. Adults need a sustained heart-rate rise of at least 30 beats per minute (bpm) within 10 minutes of standing or tilt testing, without a drop in blood pressure. For ages 12 to 19, the rise must be at least 40 bpm (Thijs et al., 2021). So a 35 bpm rise meets the adult threshold but falls short of the teen one.
Teen and adult criteria
A higher bar for teens on a stand test
Both charts show heart rate lying down, then after standing up. The dashed line marks where it started.
Rise of at least 40 bpm
Heart rate climbs at least 40 bpm within 10 minutes of standing or tilt, without a big blood pressure drop, plus ongoing symptoms.
Rise of at least 30 bpm
For ages 20 and up, the same test needs a rise of at least 30 bpm, without a big blood pressure drop, plus ongoing symptoms.
Simplified illustration, not real patient readings. Criteria: Thijs RD et al., Clin Auton Res 2021 (PMID 33740206).
Doctors use either an active stand test (lying down, then standing still for 10 minutes) or a tilt table test, and also rule out other causes such as dehydration, anemia, thyroid problems or a heart rhythm disorder. Our posts on how POTS is diagnosed and what happens during a tilt table test walk through both.
First-line care for teens usually starts with daily habits: more fluids, more salt if the doctor approves it, compression garments, rising slowly, and avoiding long periods of standing still. Many teens also take medication for specific symptoms. In the CHOP group, the researchers counted a medication as effective when the same dose was prescribed at least five times in a row without changes. By that measure, medication was effective for lightheadedness in 52.2% of patients and for headache in 48.2%. The authors note that controlled trials are still needed (Boris and Bernadzikowski, 2018, medication study). These measures help many teens, and they stay in the plan even if you add other treatment. Our guide to compression socks for POTS covers what to buy.
The best-studied exercise approach for POTS came from Dr. Benjamin Levine's group in Dallas. In their first study, 25 patients started a 3-month training program and 19 finished. Ten of those 19 no longer met POTS criteria afterward (Fu et al., 2010). In a larger community registry, 251 people enrolled, 103 finished, and 71% of those who finished no longer met criteria (George et al., 2016).
CHOP adapted the Dallas protocol for its pediatric patients. The CHOP instructions lay out eight monthly training calendars. Months 1 to 4 use only horizontal or seated exercise, such as a recumbent bike, a rowing machine or swimming. An upright bike can come in during month 4, and other upright training such as an elliptical or treadmill starts in month 5. The instructions say many patients follow the program on their own, while others have a family member, trainer or physical therapist oversee progress (CHOP Modified Dallas POTS Exercise Program, distributed by Dysautonomia International).
Both Dallas studies lost people before the end, especially the community registry, where fewer than half finished. Ask your teen's doctor for a personal heart-rate zone, and consider a physical therapist who knows POTS. Our POTS exercise program guide covers how to start.
A pediatric POTS specialist is usually a pediatric cardiologist, a pediatric neurologist or the team at an autonomic program in a children's hospital. CHOP's Acquired Autonomic Dysfunction Program, for example, has doctors, nurses, physical therapists and psychologists for children and teens with POTS and other autonomic problems, and treatment there may include an exercise program and coping skills support (CHOP). For a child under 16, a pediatric program like this, working with your child's own doctor, is the right place to start. If your teen is 16 or older and you want a supervised option during a school break, see how our 5-day POTS treatment program works.
At school, POTS can look like a teen who can't get through first period, feels faint in a hot classroom, or misses so many days that grades slide.
Section 504 of the Rehabilitation Act covers schools that receive federal education funding. A student can qualify if a physical or mental impairment substantially limits one or more major life activities, and the school must then provide services designed to meet that student's individual needs (U.S. Department of Education, Office for Civil Rights). Whether your teen qualifies is a school decision, so bring a letter from the treating doctor describing the diagnosis and how it affects the school day.
Accommodations to discuss with the school include:
For more on how POTS is treated under disability law, see our post Is POTS a disability? Your school's 504 coordinator can explain the local process.
Standard care and a home exercise plan come first for most teens. Families look at intensive programs when:
An intensive program adds to your teen's existing care. The doctor, medications and home routine all stay in place. If your teen is under 16, our program is not an option yet. Please work with your child's pediatrician and a pediatric POTS clinic, and keep us in mind once your teen turns 16.
Whether you are looking at a children's hospital, a specialist or an intensive program like ours, these questions help you compare:
We can provide a letter for your teen's school. We also work with your teen's own doctor: if you share the doctor's contact information and sign an authorization, we send the doctor a summary package, and the doctor keeps managing medication. Our guide to choosing the right POTS clinic covers the main types of POTS care in more detail.
Does this sound like your teen?
Signs it may be time to talk with us
If this sounds like your teen, talk with our POTS team about whether the 5-day program fits.
Book my free consultStarts with our POTS intake form. This list is not a diagnosis. Prefer to talk? Call (385) 375-8590.
Our program grew out of treating post-concussion patients who also had POTS symptoms, and we now treat POTS patients frequently. It is built on the idea that POTS involves how the nervous system adjusts heart rate and blood flow when you stand. So along with the usual tools, we train that adjustment directly.
Your week in Provo
What the 5 days look like
Day 1 covers your teen's orthostatic response (how heart rate and blood pressure react to standing, including tilt table testing), vestibular function (the balance system), cranial nerve inputs and breathing mechanics. If you arrive early, we can work in an fMRI brain scan. Ask on the consult when to arrive. An fMRI is a type of MRI scan. It uses magnets and does not involve radiation, and your teen lies still in the scanner while it records brain activity. A diagnosis helps but is not required, and we can help with the diagnostic process.
Each treatment day runs 4 to 6 hours. Breathing retraining works on how the body handles carbon dioxide, the Cranial Nerve Stack is a short routine your teen does each morning before getting out of bed, and NeuroCardio Training is supervised interval training with heart-rate monitoring that focuses on recovery between efforts.
Salt, fluids, compression and any medication your teen's doctor prescribed stay in place. At the end of the week, your teen goes home with a written home program, and we schedule Zoom follow-ups as needed.
Research on breathing in POTS is early. In one lab study of 30 people with POTS, slow breathing (6 breaths a minute) during a single tilt test lowered the heart-rate rise by about 7 beats per minute and eased symptoms (Stick et al., 2024). That study tested one session of slow breathing, not our program.
Every exercise session is supervised with heart rate and blood pressure monitors. If your teen feels faint during a session, staff have them lie down and help them recover with breathing work and extra fluids.
Your teen's care team in Provo
The people who will treat your teen
Dr. Alina K. Fong, PhDClinical Director
Dr. Lynn M. Gaufin, MDDirector of Neurosurgery
Sotero Perigo, MS, ATCNeuroMuscular Therapist
Annie Morgan, RNDirector of Patient Care
Plus other therapists as needed. Meet the full team
Treatment takes 5 days in Provo, Utah, so you may want to plan it around a school break. We can provide a letter for your teen's school. It usually takes 1 to 2 weeks to get a free consult, and start dates are usually booked one to two months out. A parent or guardian must come with any patient under 18 and stay in Provo for the whole week. Travel and lodging are not included in the program price. Our travel information page has details for families coming from out of town.
For the longer-term outlook, see our post on whether POTS goes away.
Many improve. In a Mayo Clinic survey of people diagnosed with POTS between ages 13 and 18, answered an average of 5.4 years later, 19% reported complete resolution, 51% reported persistent but improved symptoms, and 16% had only intermittent symptoms. Only about a third of those surveyed responded, so the true picture may differ (Bhatia et al., 2016).
No. Our POTS program accepts patients ages 16 and up. If your child is younger, please work with their pediatrician and a pediatric POTS clinic, such as a program at a children's hospital. We are glad to talk with your family once your teen turns 16.
After the POTS intake form is done, you pick a time for a free 15 to 30 minute video call on Zoom. Our team goes over your teen's symptoms, tests and treatment so far, answers your questions about cost, travel and safety, and tells you whether we think the 5-day program is a good fit. Your teen can join the call with you, and you can both ask about consent and how your teen takes part in decisions. You can also call (385) 375-8590.
The 5-day program costs $4,500. Families can pay by credit card, finance through CareCredit, or use an HSA or FSA if their plan allows. Travel and lodging are not included.
Every exercise session is supervised with heart rate and blood pressure monitors. If your teen feels faint during a session, staff have them lie down and help them recover with breathing work and extra fluids. If your teen has fainted and been injured, has chest pain with exertion, or has known heart disease, see their doctor first and mention it on your consult. If your teen crashes for days after light activity, please call us at (385) 375-8590 before booking a consult.
Yes. A parent or guardian must come with any patient under 18 and stay in Provo for the whole week, and parents can attend or be present for most therapies.
Next steps
Ready to talk with our team about your teen?
Book my free consult Read about the POTS program
Questions first? Call (385) 375-8590. For ages 16 and up. A parent or guardian must come with any patient under 18.
This article is general education and is not medical advice. Talk with your teen's doctor before changing medication, salt or fluid intake, or starting an exercise program.
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