Fatigue in children
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Synonyms and keywords: Fatigue in kids
Overview
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[1]
- Cancer[2] Reduced
- Cardiac septal defect
- Diabetes
- Obesity
- Cushing's syndrome[1]
- Inflammatory bowel disease[3]
- Multiple sclerosis[4]
- Reduced physical fitness
- Anxiety [5]
- Fibromyalgia
- Juvenile rheumatoid arthritis
- Intussusception
- Depression[5]
- 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[6].
- 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[6]..
Gender
Girls are more commonly affected by fatigue than boys. The female to male ratio is approximately 1.3 to 1.[7]
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[8].
- 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[8]:
- 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[8]:
- 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[8]:
- 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 fatigue in children.
Echocardiography or Ultrasound
There are no echocardiography/ultrasound findings associated with fatigue in children.
CT scan
There are no CT scan findings associated with fatigue in children.
MRI
There are no MRI findings associated with fatigue in children.
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
- 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].
References
- ↑ 1.0 1.1 Nutini M, Karczewski M, Capoor J (2009). "Fatigue in children with neurologic impairments". Phys Med Rehabil Clin N Am. 20 (2): 339–46. doi:10.1016/j.pmr.2008.12.004. PMID 19389615.
- ↑ Wolfe J, Grier HE, Klar N, Levin SB, Ellenbogen JM, Salem-Schatz S; et al. (2000). "Symptoms and suffering at the end of life in children with cancer". N Engl J Med. 342 (5): 326–33. doi:10.1056/NEJM200002033420506. PMID 10655532.
- ↑ van Langenberg DR, Gibson PR (2010). "Systematic review: fatigue in inflammatory bowel disease". Aliment Pharmacol Ther. 32 (2): 131–43. doi:10.1111/j.1365-2036.2010.04347.x. PMID 20456309.
- ↑ Amato MP, Goretti B, Ghezzi A, Lori S, Zipoli V, Portaccio E; et al. (2008). "Cognitive and psychosocial features of childhood and juvenile MS". Neurology. 70 (20): 1891–7. doi:10.1212/01.wnl.0000312276.23177.fa. PMID 18474844.
- ↑ 5.0 5.1 Van de Vijver E, Van Gils A, Beckers L, Van Driessche Y, Moes ND, van Rheenen PF (2019). "Fatigue in children and adolescents with inflammatory bowel disease". World J Gastroenterol. 25 (5): 632–643. doi:10.3748/wjg.v25.i5.632. PMC 6371006. PMID 30774277.
- ↑ 6.0 6.1 Haines LC, Saidi G, Cooke RW (2005). "Prevalence of severe fatigue in primary care". Arch Dis Child. 90 (4): 367–8. doi:10.1136/adc.2003.039917. PMC 1720362. PMID 15781924.
- ↑ ter Wolbeek M, van Doornen LJ, Kavelaars A, Heijnen CJ (2006). "Severe fatigue in adolescents: a common phenomenon?". Pediatrics. 117 (6): e1078–86. doi:10.1542/peds.2005-2575. PMID 16740810.
- ↑ 8.0 8.1 8.2 8.3 Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A (1994). "The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group". Ann Intern Med. 121 (12): 953–9. doi:10.7326/0003-4819-121-12-199412150-00009. PMID 7978722.
- ↑ Crichton A, Knight S, Oakley E, Babl FE, Anderson V (2015). "Fatigue in child chronic health conditions: a systematic review of assessment instruments". Pediatrics. 135 (4): e1015–31. doi:10.1542/peds.2014-2440. PMID 25802352.
- ↑ Varni JW, Burwinkle TM, Szer IS (2004). "The PedsQL Multidimensional Fatigue Scale in pediatric rheumatology: reliability and validity". J Rheumatol. 31 (12): 2494–500. PMID 15570657.
- ↑ Varni JW, Limbers CA, Bryant WP, Wilson DP (2009). "The PedsQL Multidimensional Fatigue Scale in type 1 diabetes: feasibility, reliability, and validity". Pediatr Diabetes. 10 (5): 321–8. doi:10.1111/j.1399-5448.2008.00482.x. PMID 19067887.
- ↑ Hockenberry MJ, Hinds PS, Barrera P, Bryant R, Adams-McNeill J, Hooke C; et al. (2003). "Three instruments to assess fatigue in children with cancer: the child, parent and staff perspectives". J Pain Symptom Manage. 25 (4): 319–28. doi:10.1016/s0885-3924(02)00680-2. PMID 12691683.
- ↑ Chiang YC, Hinds PS, Yeh CH, Yang CP (2008). "Development and psychometric testing of a Chinese version of the Fatigue Scale-Children in Taiwan". J Clin Nurs. 17 (9): 1201–10. doi:10.1111/j.1365-2702.2007.02138.x. PMID 18416796.