Background: The objective is to compare the frequency and clinical characteristics of pediatric Postural Orthostatic Tachycardia syndrome (POTS) diagnoses before and during the Coronavirus Disease 2019 (COVID-19) pandemic and assess potential contributing factors.

Methods: This retrospective study analyzed 117 pediatric patients diagnosed with POTS between January 2018 and December 2023 at a single tertiary center. Patients were
divided into pre-pandemic (n = 46) and pandemic (n = 71) groups. Clinical, laboratory, and psychosocial data were collected and compared. Logistic regression was used to identify independent predictors of pandemic-period diagnoses.

Results: A significant increase in POTS diagnoses was observed during the pandemic (10.5% vs. 6.1%, P= .01). Pandemic-period patients reported lower physical activity (72%) and higher screen time (85%), with increased symptoms of anxiety (34% vs. 18%, P= .04) and palpitations (P= .03). Vitamin B12 levels were higher in the pandemic group (P= .043), while hemoglobin levels and heart rate variability remained similar across groups.

Conclusion: The COVID-19 pandemic was associated with a marked rise in pediatric POTS diagnoses, likely driven by lifestyle alterations and psychosocial stress rather than nutritional deficiencies. These findings underscore the importance of early recognition, physical reconditioning, and psychological support in managing POTS, particularly during global health crises.