Fatigue resident survival guide (pediatrics)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Usman Ali Akbar, M.B.B.S.[2]

Synonyms and keywords: Fatigue, Pediatric Fatigue, Approach to weakness, Approach to tiredness, Approach to lethargy, Approach to debility

Fatigue resident survival guide (pediatrics) Microchapters


Fatigue, a subjective feeling of exhaustion is a state of being less active.Fatigue in childhood has been associated with poor quality of life, and is usually a benign condition. Fatigue and weakness, are sometimes difficult to define. Fatigue involves extreme and unusual tiredness with decreased performance and sometimes irritability. The differential diagnosis of fatigue in pediatrics encompasses different underlying systemic disorders. Emergent evaluation and treatment of fatigue is rarely required except in some selected conditions. Both non-pharmacological and pharmacological treatment options are utilized in the treatment of fatigue.


General Causes Behavorial/Psychological Infections Medication Induced Metabolic Chronic Conditions

Complete Diagnostic Approach

Patient presents with the complaint of new-onset fatigue
Physical Exam
Diagnostic Tests

Basic Screening Tests

Additional Tests

  ❑Indicated if fatigue persists, diagnosis remains uncertain, or symptoms of neurally mediated hypotension are present 
❑Abnormal pooling of blood in lower extremities
❑Automated oscillometer facilitates process
Tilt-table testing
Cause Identified
Manage Accordingly
Unexplained fatigue
Psychological component likely?

Lifestyle advice as appropriate ❑Behavioral Changes

❑Rule out and manage according to the psychological cause


Shown below is an algorithm summarizing the treatment of fatigue in children and adolescent population:

Treatment should be according to the cause of fatigue and should meet individual patient's requirements.
Non-Pharmacological Treatment
Pharmacological Treatment

Advice the adolescent and teenager to get less sleep.

•Reduce the TV watching hours especially at bedtime
•Complete at least 8h per day of sleep time
•Schedule your sleep at the same time every night
•Avoid vigorous activity or exercise in the evening
•Avoid caffeinated drinks or products in the evening
•Avoid nap during the day
•Consume light snacks during the day

Exercise plus leisure activities
❑Exercise plus psychosocial intervention
❑Healing touch

❑Give 10 to 20 mL/kg of 0.9% normal saline, or other isotonic solution, administered as an IV bolus
❑Mild DKA – 10 mL/kg bolus
❑Moderate or severe DKA – 20 mL/kg bolus
Insulin : Begin a continuous insulin infusion at 0.1 units/kg per hour.◊ Mix 50 units of regular insulin in 50 mL of saline(0.45% or 0.9% NaCl).
Serum Electrolytes Correction

Fluids and electrolytes – Give a bolus of D5 normal saline (5% dextrose with 0.9% saline, without potassium), 20 mL/kg intravenously over one hour.
Glucocorticoids and mineralocorticoids
•0-3 years old – Hydrocortisone 25 mg IV
•3-12 years old – Hydrocortisone 50 mg IV
•12 years and older – Hydrocortisone 100 mg IV




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