Postural orthostatic tachycardia syndrome (POTS) affects children and adolescents—normally fit and well and yet troubled by a myriad of everyday symptoms. Understanding the pathophysiology of this not uncommon disorder together with a review of the clinical features may well assist the attending clinicians to arrive at a clear diagnosis without the need for extensive testing and multiple investigations. Simple lifestyle measures such as increasing fluid intake, electrolyte and/or salt supplements, adequate sleep, not missing out on meals and instituting an exercise programme to improve muscle tone and strength may avoid the need of pharmacological management. These simple measures may benefit symptoms which generally improve as adulthood approaches. In addition, it is important to recognise the comorbidities that may be associated with POTS, each of which may require specific management strategies. This paper reviews the pathophysiology, clinical features and recommended treatment in the management of POTS.