| disease | Orthostatic Dysregulation in Children |
Orthostatic dysregulation is a syndrome primarily caused by unstable autonomic nervous function in children, with main clinical manifestations including dizziness, flusteredness, nausea, and chest tightness upon waking or standing upright. It is a common condition during childhood and is self-limiting with a good prognosis. Due to the incomplete development and functional instability of the autonomic nervous system in children, vasomotor responses may sometimes be inadequate, especially during postural changes such as transitioning from lying to standing, leading to transient cerebral anemia and other symptoms. In healthy individuals, blood vessels in the lower limbs reflexively constrict immediately upon standing from a supine position to ensure sufficient blood return to the heart, maintaining adequate circulation for both the upper and lower body to support normal physiological functions. However, children with this condition may experience symptoms such as dizziness and nausea in such situations.
bubble_chart Diagnosis
(I) Main Criteria 1. Dizziness upon waking, lack of energy. 2. Discomfort after standing upright. 3. Positive orthostatic test.
(II) Secondary Criteria 1. Easily fatigued. 2. Flusteredness, chest tightness after mild activity. 3. Prone to motion sickness. 4. Dizziness or flusteredness, chest tightness during hot baths. Diagnosis can be confirmed if one main criterion and two secondary criteria are met; or if two main criteria are met. However, organic diseases must be ruled out first.
[Orthostatic Test Method and Result Interpretation]
The subject lies flat, and a standard 9-lead ECG is recorded followed by blood pressure measurement. Then, the subject stands up and remains quietly upright for 10 minutes. The ECG and blood pressure are measured again, and the changes in heart rate, pulse pressure, and T-wave before and after standing are compared. The test is considered positive if two or more of the following four criteria are met: (1) Heart rate increase ≥20 beats/min after standing; (2) Systolic blood pressure drop ≥2.6 kPa (20 mmHg) after standing; (3) T-wave decrease ≥0.2 mV or 50% in two or more leads after standing; (4) Pulse pressure reduction ≥1 kPa (16 mmHg) after standing. If the subject faints during the test and the procedure cannot continue, the orthostatic test is also judged as positive.
﹝Treatment﹞
(1) Psychotherapy is very important. Experience has shown that as children grow and develop, the autonomic nervous system gradually matures, and most symptoms naturally disappear before puberty. Understanding this greatly helps alleviate the psychological burden on both the child and parents, facilitating normal life and learning, and promoting early recovery.
(2) Take corresponding measures based on the disease cause. Appropriate limb movement before getting up can enhance sympathetic nerve excitability, and avoiding sudden movements when rising can reduce or alleviate symptom episodes.
(3) Physical therapy. Wipe the limbs with a dry or cold towel before sleep and upon waking, and actively participate in sports and outdoor winter exercises to improve vasomotor function and enhance vascular nerve responsiveness, aiding symptom recovery.
(4) Drug therapy. Oryzanol is commonly used to regulate the autonomic nervous system, with a dose of 20mg each time, three times daily. The dose is halved after symptoms disappear, with a treatment course of three months, though the effects are often not very significant. Other symptomatic treatments are generally unnecessary.
