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Paediatrics: Chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is defined as generalized fatigue persist-ing after routine tests and investigations have failed to identify underlying cause.

Chronic fatigue syndrome

 

Chronic fatigue syndrome (CFS) is defined as generalized fatigue persist-ing after routine tests and investigations have failed to identify underlying cause. The fatigue in CFS may be associated with other symptoms:

   Difficulty in concentrating; cognitive dysfunction.

 

   Disturbed sleep.

 

   Fatigue (both mental and physical) exacerbated by effort.

 

   The diagnosis should be made as soon as it is clear that the symptoms are causing functional impairment and no alternative explanation has been found (3mths in children).

 

Investigation

 

Routine investigations need to be undertaken to rule out plausible alterna-tive causes. Second-line investigations are only undertaken if symptoms/ signs or investigations suggest a particular diagnosis.

 

Investigations for chronic fatigue syndrome

 

   FBC and film, ESR

 

   Glucose, biochemistry, CK (muscle), liver function test

 

   Thyroid tests

 

   Urine to exclude renal disease

 

   Screening tests for gluten sensitivity

 

   Assessment of ferritin levels

 

   EBV or viral tests only if history indicates recent infection

 

An assessment of psychological well-being is essential and psychiatric dis-orders need to be excluded. Psychological morbidities such as anxiety and depression are common and important to recognize.

 

Management

 

There is no one single approach for all patients with CFS, but as a mini-mum the following should be addressed.

 

Activity management.

 

Establish baseline level and gradually increase as appropriate. Referral to physiotherapy and occupational therapy to supervise programme and treat symptoms. It is widely assumed that the correct approach is the use of graded activity and CBT, as supported by the literature in adults. However, some patients find it unacceptable to use psychological treat-ments and have found that any exercise is to be avoided. Parental men-tal illness, especially depression and anxiety, should be assessed. Treating these presentations may be important in a holistic treatment plan.

 

Other management

 

   Symptomatic treatment for pain, sleep.

 

   Dietary advice (e.g. poor appetite or weight gain due to immobility).

 

Treatment for depression and mood disorders—need referral to child psychiatry team.

CFS and education

 

CFS causes significant disruption to school. The length of absence from school depends on severity and will range from part time attendance to home tuition for many years. Liason with the school is essential in order to formulate a plan for return. Support in school may be needed for mobility or learning, and for some a statement of special educational needs will be required. If the child is too unwell to attend school, home tuition can be organized with support from the paediatrician but the maximum per week is usually a few hours and the child’s needs should be monitored closely.

 

 

Prognosis

 

Severe or very severe CFS (house bound or bedridden for 3mths) on rare occasions requires admission to hospital. Some cases the condition may persist for many years. Generally, though, outcome is favourable.1

 

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