Prioritizing Function: Practical Management of Orthostatic Intolerance and Autonomic Dysfunction

Chronic orthostatic intolerance (COI), a common symptom of autonomic dysfunction (AD), in adolescents is a heterogeneous condition characterized by symptoms that worsen upon standing and improve with recumbency. Nonpharmacologic management is the foundation of treatment and focuses on restoring autonomic balance, improving conditioning, and supporting functional recovery. This review summarizes current evidence-based strategies, including volume expansion through increased fluid and salt intake, use of compression garments, and gradual reconditioning exercises. Additional approaches, such as optimizing sleep, nutrition, and psychological well-being, address the multifactorial contributors to COI/AD. Education and reassurance play key roles in reducing symptom-related anxiety and promoting adherence. A multidisciplinary approach involving clinicians, families, and schools can enhance long-term outcomes. Emphasizing functional improvement fosters resilience and recovery, aligning treatment goals with adolescent development and quality of life. Clinicians should prioritize early education and behavioral interventions to promote sustainable recovery without reliance on medication.