POTS in Children With Lyme Disease: A Hidden Autonomic Disorder

DOES LYME CAUSE POTS?

DIZZINESS. RAPID HEART RATE.
WORSE WHEN STANDING?

These symptoms are often mistaken for anxiety or behavioral problems—delaying diagnosis and treatment.

POTS in children with Lyme disease is frequently overlooked, even though it reflects a physiologic disorder affecting circulation and autonomic nervous system regulation.

For a broader overview, see POTS in Lyme disease.

Can Lyme Disease Cause POTS?

Lyme disease can affect the autonomic nervous system through inflammation, immune dysregulation, and disruption of nerve signaling that regulates heart rate and blood pressure.

In children, this may present as POTS or other forms of orthostatic intolerance, particularly when symptoms worsen upon standing.

Common Symptoms of POTS in Lyme Disease

• Dizziness or lightheadedness when standing
• Rapid heart rate (tachycardia)
• Fatigue or exercise intolerance
• Headaches
• Nausea or abdominal discomfort
• Difficulty concentrating or brain fog

These symptoms often worsen when standing and improve when lying down.

Children do not always describe classic orthostatic symptoms clearly. Instead, they may report vague or fluctuating complaints.

POTS in Children With Lyme Disease May Look Different

POTS occurs when the autonomic nervous system has difficulty regulating circulation after a child stands up.

In adults, diagnosis typically involves a heart rate increase of at least 30 beats per minute within 10 minutes of standing. In children and adolescents, the threshold is generally 40 beats per minute.

Why Lyme Disease Can Trigger POTS

Lyme disease can affect autonomic regulation through infection-related inflammation, immune dysregulation, and disruption of nerve signaling.

These changes can leave children feeling significantly worse when upright.

This is one reason POTS in Lyme disease is frequently overlooked in children.

In clinical practice, children with these symptoms are sometimes first evaluated for anxiety or behavioral concerns before the physiologic basis is recognized.

Orthostatic Symptoms Parents Often Notice First

Parents may notice patterns such as worsening symptoms when standing in line, after a hot shower, during sports, or while walking.

Many children feel better when lying down, only to worsen again when upright.

Looking Beyond POTS: Other Autonomic Problems

While POTS is one of the best recognized forms of dysautonomia, it is not the only pattern seen in children with Lyme disease.

• Orthostatic intolerance without classic POTS findings
• Neurally mediated hypotension
• Temperature regulation problems
• Digestive system dysregulation
• Autonomic neuropathy

Focusing only on POTS may cause clinicians to overlook other forms of autonomic dysfunction.

School Performance and Daily Function

Autonomic symptoms can interfere with school attendance, concentration, and participation.

These difficulties are sometimes misinterpreted as anxiety or lack of motivation when the underlying issue is physiologic.

Symptoms Often Fluctuate

Symptoms may come and go, worsening with stress, illness, dehydration, heat, or overexertion.

This fluctuating pattern reflects real autonomic dysfunction—not behavioral causes.

Evaluation of POTS in Children With Lyme Disease

Evaluation typically begins with a careful history and measurement of heart rate and blood pressure changes from lying to standing.

Assessment may also include evaluation for infection, inflammation, and contributing factors.

Management Considerations

Management may include hydration strategies, salt intake, pacing, gradual physical reconditioning, and treatment of underlying contributors.

For more, see POTS in Lyme disease and autonomic dysfunction in Lyme disease.

Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention