Telemedicine Follow Up Facilitates Favorable Outcomes in Pediatric Patients with Significant Orthostatic Intolerance

Orthostatic intolerance and postural orthostatic tachycardia syndrome (POTS) are increasingly recognized conditions in pediatrics, often requiring intensive counseling and trials of medications as part of the eventually successful management. Telemedicine offers potential benefits for follow up care in this population. To evaluate clinical outcomes and quality of life (QOL) in pediatric patients with orthostatic intolerance managed through telemedicine follow up, a retrospective chart review was conducted on 220 pediatric patients with significant orthostatic intolerance symptoms who received telemedicine follow up between January 2024 and May 2025. Patients were triaged following initial clinic assessment and managed with lifestyle modifications, iron and vitamin D supplementation when indicated, and potentially medications. QOL was assessed on a 1-10 scale. Baseline and follow up QOL scores were compared over time. The cohort was 94.5% female with a mean age of 15.3 ± 2.0 years; 36.3% of the patients met criteria for a diagnosis of POTS. Over an average follow up of 17.8 months, QOL scores improved significantly from 5.6 at baseline to 7.7 at the last visit (p < 0.005) and 8.2 at best reported visit (p < 0.005). Symptom prevalence decreased notably, particularly lightheadedness, palpitations, and fatigue. Telemedicine follow up for pediatric orthostatic intolerance is associated with significant improvements in symptom burden and quality of life. Frequently scheduled visits can improve follow up rate and compliance as well as support effective use of clinical resources.