Abstract
Orthostatic dysregulation (OD) is mainly caused by circulatory dysregulation by the autonomic nervous system, but it can be psychosomatic and may be associated with school refusal. Here, we investigated the causes of school refusal and problems specific to the COVID-19 pandemic in pediatric patients meeting the diagnostic criteria for psychosomatic OD. This study involved 67 patients with OD (20 boys, 47 girls) who visited the pediatric outpatient department from April 1, 2020 to October 31, 2021. Mean age was 13.7 ± 2.4 years. The subtypes of OD included postural tachycardia syndrome (POTS) in 43 cases, delayed orthostatic hypotension (delayed OH) in 15 cases, instantaneous orthostatic hypotension (INOH) and vasovagal syncope (VVS) with INOH in 1 case each , and 7 other cases that met the conventional diagnostic criteria. Of the 67 patients, 37 met the diagnostic criteria for psychosomatic OD and 22 had a history of long-term school refusal. The COVID-19 pandemic, school closures, and suspected school infections have completely changed the living environment for children. As a result, these children could not rest at school and were forced to return home early. They had worsening of symptoms that was thought to be due to disruptions of daily rhythms caused by staying at home and getting insufficient exercise. At this hospital, we explain the pathophysiology of the autonomic nervous system, provide lifestyle guidance to patients and their families, cooperate with schools with consideration of school refusal and each child’s mental and physical condition, and cooperate with psychiatry. This paper discusses problems and countermeasures specific to the COVID-19 pandemic.
