Postural tachycardia syndrome (POTS) is a heterogeneous disorder that creates challenges for treatment. Beta-blocker was one of the most commonly used drugs, but it is inconsistently effective. The purpose of this study is to explore whether orthostatic plasma norepinephrine level could be an indicator of therapeutic effectiveness of metoprolol for POTS in children. Twenty-seven children with POTS were enrolled in our study. They received metoprolol treatment, and their orthostatic plasma norepinephrine levels were measured by high-performance liquid chromatography method. Three months after rmetoprolol treatment, 25 patients were followed up. A receiver-operating characteristic (ROC) curve was used to explore the predictive value of orthostatic plasma norepinephrine level. The symptom severity and increment of heat rate from supine position to upright of patients positively correlated with their orthostatic plasma norepinephrine level (r = 0.599, P < 0.001; r = 0.633, P 3.59 pg/ml was an indicator of the effectiveness of metoprolol therapy for POTS in children and adolescents.