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INTRODUCTION

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Generalized fatigue is a frequent complaint during many common pediatric infectious illnesses. Additionally, chronic diseases of childhood often are characterized by associated fatigue. The symptoms experienced by children with these conditions typically resolve with treatment of the acute illness or of the underlying chronic disease. In contrast, chronic fatigue syndrome (CFS) is distinguished by prolonged fatigue and associated constitutional symptoms that persist after improvement in the triggering disorder. CFS may be a debilitating illness that significantly impacts activities of daily living and family dynamics. A systematic approach directed at first ruling out identifiable causes of profound fatigue and associated symptoms is essential before arriving at the diagnosis of CFS. Through a careful history and physical exam and narrowly focused laboratory testing based on clinical presentation, underlying diseases responsible for fatigue may be eliminated. Attention then switches to maximizing the ability to function and initiating an appropriate treatment plan. Although the specific cause of this illness remains to be elucidated and appropriate treatment strategies continue to be controversial, a multidisciplinary, holistic, symptom-based approach can provide the best tools for managing CFS and achieving full recovery.

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EPIDEMIOLOGY

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The symptoms of CFS-like illnesses were described in adults for many years, even prior to the acceptance of specific diagnostic and research criteria. However, the recognition that this illness affects children is a relatively recent phenomenon. Bell and colleagues initially described a cluster of pediatric patients who presented during the late 1980s with symptoms consistent with CFS and further defined the incidence in a rural community through a retrospective review. During the past several years, several published reports have demonstrated that prolonged fatigue states and CFS do indeed occur in the pediatric population, and in fact, they may not be rare. Although the etiology of CFS remains unknown, reports of clusters of cases imply that environmental triggers, such as infection, may play a role.

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Children of all ages may present with CFS, but evidence suggests that it is more common in the adolescent population than in younger children. The incidence and prevalence of CFS in children are somewhat difficult to assess given the absence of specific pediatric criteria, geographical variations, and other variables. Nonetheless, a few key studies in the 1990s were performed: one indicated that Australian children reported an overall prevalence of 37 per 100,000, whereas another retrospective study done by Bell in the United States reported an estimated prevalence of 23 per 100,000. Most recently, the Centers for Disease Control and Prevention (CDC) estimated that between 0.2% and 2.3% of children or adolescents suffer from CFS. As is the case in adults, pediatric CFS seems to be more common in girls, with an overall female-to-male ratio of 2:1, although some studies have failed to demonstrate such a female predominance. In addition, children in higher socioeconomic groups appear be affected more frequently.

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PATHOPHYSIOLOGY

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As in adults, the specific mechanisms ...

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