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

Overview

Fatigue is a symptom defined by a subjective sense of increased more than average tiredness and exhaustion after a routine task that impairs one’s physical and mental capabilities[1]. The chronic fatigue syndrome is defined as severe persistent debilitating fatigue for six months or more along with somatic symptoms like myalgia, headache, joint pain and sore throat[2]. The incidence of fatigue is high in children particularly in adolescence due to high education and psychosocial stress[3]. It can have severe debilating adverse effects on children and negatively impact their academic and social life.The fatigue can also be a symptom of an underlying disease. Hence, a thorough clinical evaluation and relevant investigations should be performed to rule out any underlying pathology.

Classification

Pathophysiology

Causes

Fatigue may be caused by

Differentiating fatigue from other Diseases

Chronic fatigue in children should be differentiated from other symptoms that result in extreme tiredness like sleeplessness and muscle weakness[5]. These symptoms can be differentiated by thorough examination of the patient. The symptoms of tiredness due to sleeplessness are alleviated by adequate sleep and adjusting sleep wake cycle[9]. The muscle weakness is mainly due to underlying pathogy at the neuromuscular junction. It is tested by detailed neurological examination assessing muscle motor strength testing[5].

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[10].
  • 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[10]..

Gender

Girls are more commonly affected by fatigue than boys. The female to male ratio is approximately 1.3 to 1.[3]

Race

There is no racial predilection for fatigue in children.

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

  • Any underlying medical or psychiatric illness has been ruled out.

Symptoms

  • 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[2]:

Laboratory Findings

  • Laboratory findings consistent with the diagnosis of fatigue in children due to underlying diseases include[2]:

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 fatigue in children.

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

Surgery

Prevention

  • There are no primary preventive measures available for fatigue.

References

  1. 1.0 1.1 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.
  2. 2.0 2.1 2.2 2.3 2.4 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.
  3. 3.0 3.1 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.
  4. Lloyd AR, Wakefield D, Hickie I (1993). "Immunity and the pathophysiology of chronic fatigue syndrome". Ciba Found Symp. 173: 176–87, discussion 187-92. doi:10.1002/9780470514382.ch11. PMID 8491097.
  5. 5.0 5.1 5.2 5.3 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.
  6. 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.
  7. 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.
  8. 8.0 8.1 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.
  9. Shen J, Barbera J, Shapiro CM (2006). "Distinguishing sleepiness and fatigue: focus on definition and measurement". Sleep Med Rev. 10 (1): 63–76. doi:10.1016/j.smrv.2005.05.004. PMID 16376590.
  10. 10.0 10.1 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.
  11. Carter BD, Marshall GS (1995). "New developments: diagnosis and management of chronic fatigue in children and adolescents". Curr Probl Pediatr. 25 (9): 281–93. doi:10.1016/s0045-9380(06)80057-5. PMID 8582157.
  12. Bell KM, Cookfair D, Bell DS, Reese P, Cooper L (1991). "Risk factors associated with chronic fatigue syndrome in a cluster of pediatric cases". Rev Infect Dis. 13 Suppl 1: S32–8. doi:10.1093/clinids/13.supplement_1.s32. PMID 2020801.
  13. 13.0 13.1 Rimes KA, Goodman R, Hotopf M, Wessely S, Meltzer H, Chalder T (2007). "Incidence, prognosis, and risk factors for fatigue and chronic fatigue syndrome in adolescents: a prospective community study". Pediatrics. 119 (3): e603–9. doi:10.1542/peds.2006-2231. PMID 17332180.
  14. Mears CJ, Taylor RR, Jordan KM, Binns HJ, Pediatric Practice Research Group (2004). "Sociodemographic and symptom correlates of fatigue in an adolescent primary care sample". J Adolesc Health. 35 (6): 528e.21–6. doi:10.1016/j.jadohealth.2004.02.012. PMID 15581533.
  15. Carter BD, Edwards JF, Kronenberger WG, Michalczyk L, Marshall GS (1995). "Case control study of chronic fatigue in pediatric patients". Pediatrics. 95 (2): 179–86. PMID 7838632.
  16. 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.
  17. 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.
  18. 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.
  19. 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.
  20. 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.
  21. 21.0 21.1 Crawley E (2017). "Pediatric chronic fatigue syndrome: current perspectives". Pediatric Health Med Ther. 9: 27–33. doi:10.2147/PHMT.S126253. PMC 5919160. PMID 29722371.
  22. Gordon BA, Knapman LM, Lubitz L (2010). "Graduated exercise training and progressive resistance training in adolescents with chronic fatigue syndrome: a randomized controlled pilot study". Clin Rehabil. 24 (12): 1072–9. doi:10.1177/0269215510371429. PMID 20605858.
  23. Segal TY, Hindmarsh PC, Viner RM (2005). "Disturbed adrenal function in adolescents with chronic fatigue syndrome". J Pediatr Endocrinol Metab. 18 (3): 295–301. doi:10.1515/jpem.2005.18.3.295. PMID 15813608.
  24. 24.0 24.1 Rowe PC, Underhill RA, Friedman KJ, Gurwitt A, Medow MS, Schwartz MS; et al. (2017). "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Diagnosis and Management in Young People: A Primer". Front Pediatr. 5: 121. doi:10.3389/fped.2017.00121. PMC 5474682. PMID 28674681.
  25. Tucker P, Haig-Ferguson A, Eaton N, Crawley E (2011). "What to do about attention and memory problems in children with CFS/ME: a neuropsychological approach". Clin Child Psychol Psychiatry. 16 (2): 215–23. doi:10.1177/1359104511403585. PMID 21571764.