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:
in concentrating; cognitive dysfunction.
(both mental and physical) exacerbated by effort.
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
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.
and film, ESR
biochemistry, CK (muscle), liver function test
to exclude renal disease
tests for gluten sensitivity
of ferritin levels
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.
There is no one single approach
for all patients with CFS, but as a mini-mum the following should be addressed.
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
Symptomatic treatment for pain, sleep.
Dietary advice (e.g. poor appetite or weight gain
due to immobility).
for depression and mood
disorders—need referral to child psychiatry
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
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