Fatigue in children

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Synonyms and keywords: Fatigue in kids

Historical Perspective

• [Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
• In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
• In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

Classification

• [Disease name] may be classified according to [classification method] into [number] subtypes/groups:

• [group1]
• [group2]
• [group3]

• Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

Pathophysiology

• The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
• The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
• On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
• On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

Causes

Fatigue may be caused by

• Anemia
• Congestive heart failure
• Cancer Reduced
• Cardiac septal defect
• Diabetes
• Obesity
• Cushing's syndrome
• Inflammatory bowel disease
• Multiple sclerosis
• Reduced physical fitness
• Anxiety
• Fibromyalgia
• Juvenile rheumatoid arthritis
• Intussusception
• Depression
• Obstructive sleep apnea
• Cystic fibrosis
• Strained family relations

Differentiating [disease name] from other Diseases

For further information about the differential diagnosis, click here.

Epidemiology and Demographics

The prevalence of fatigue in children is approximately 59,000 to 386,000 per 100,000 individuals in terminal cancer.

Age

• The prevalence of fatigue increases with age. The fatigue commonly affects children during childhood, school, and adolescent years.
• The peak age of prevalence is 15 years. The prevalence than decreases exponentially in boys while it remains high in girls till 18 years of age..

Gender

Girls are more commonly affected by fatigue than boys. The female to male ratio is approximately 1.3 to 1.

Race

There is no racial predilection for fatigue in children.

Risk Factors

• Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis

• The majority of patients with [disease name] remain asymptomatic for [duration/years].
• Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
• If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
• Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
• Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].

Diagnosis

Diagnostic Criteria

• The diagnosis of chronic fatigue syndrome is based on the Centers for Disease Control and Prevention criteria.
• The diagnosis of chronic fatigue syndrome is made when at least four of the following eight diagnostic criteria are met and symptoms are present for more than 6 months:
• Impaired memory or concentration
• Sore throat
• Painful cervical or axillary lymph nodes
• Myalgia
• Polyarthralgia
• New onset of headache
• Unrefreshing sleep
• Malaise after exertion

Symptoms

• Symptoms of [fatigue] may include the following:

• Extreme tiredness more than normal for more than one month.
• Onset of fatigue along with exacerbating factors should be inquired.
• A detailed medical and psychiatric history should be asked to look for underlying disease or psychiatric illness.
• Systematic symptoms like breathlessness, new-onset headache, muscle aches, and joint pains.
• Substance abuse, alcohol or use of over the counter medications should be asked particularly from adolescent and teenager patients.

Physical Examination

• Physical examination may be remarkable for:

• Conjunctival pallor in anemia
• Petechia and purpura in leukemia patients
• A thorough examination to rule out psychiatric or neurologic disease
• Tenderness in multiple joints and muscle in fibromyalgia and juvenile idiopathic arthritis
• Tenderness in the cervical or axillary lymph nodes

Laboratory Findings

• Laboratory findings consistent with the diagnosis of fatigue in children due to underlying diseases include:

• Complete blood count with differential leukocyte count (to rule out anemia or leukemia)
• Erythrocyte sedimentation rate to rule out inflammatory disease.
• Alanine transaminase, aspartate transaminase, total albumin, globulin level and total protein levels to assess liver function.
• urine analysis, serum creatinine, blood urea nitrogen, serum calcium, phosphate and electrolytes to look for underlying renal disease.
• Serum Thyroid-stimulating hormone level to rule out thyroid disease.
• Fasting blood glucose levels to rule out diabetes.
• Specific neuroimaging and viral serologies like HBV, HCV, EBV should be done in patients with particular risk factors.

Electrocardiogram

There are no ECG findings associated with fatigue in children.

X-ray

There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

CT scan

There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

MRI

There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Other Imaging Findings

There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

• Fatigue in children may also be diagnosed using various modular instruments:

• Pediatric Quality of Life Inventory (PedsQL)
• Multidimensional Fatigue Scale (MFS)
• Fatigue Scale-Child [FS-C]
• Fatigue Scale-Adolescent [FS-A]

Treatment

Medical Therapy

• There is no treatment for [disease name]; the mainstay of therapy is supportive care.

• The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
• [Medical therapy 1] acts by [mechanism of action 1].
• Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery

• Surgery is the mainstay of therapy for [disease name].
• [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
• [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

Prevention

• There are no primary preventive measures available for [disease name].

• Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

• Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].