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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.

The symptoms of chronic fatigue syndrome-like illnesses had been described in adults for many years, even prior to the acceptance of specific diagnostic and research criteria.1 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 chronic fatigue syndrome and further defined the incidence in a rural community through a retrospective review.2 Over the past several years, several published reports have demonstrated that prolonged fatigue states and chronic fatigue syndrome do indeed occur in the pediatric population, and in fact they may not be rare. Although the etiology of chronic fatigue syndrome remains unknown, reports of clusters of cases imply that environmental triggers, such as infection, may play a role.

Children of all ages may present with chronic fatigue syndrome but evidence suggests that it is more common in the adolescent population than in younger children. The incidence and prevalence of chronic fatigue syndrome in children are somewhat difficult to assess given the absence of specific pediatric criteria, geographical variations, and other variables. Nonetheless, the few available data are fairly consistent: A study in Australian children reported an overall prevalence of 37 per 100,000,3 whereas the retrospective study done by Bell in the United States reported an estimated prevalence of 23/100,000.2 As is the case in adults, pediatric chronic fatigue syndrome 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.2 In addition, children in higher socioeconomic groups appear be affected more frequently.4

As in adults, the specific mechanisms through which children develop chronic fatigue syndrome remain unknown. Many theories have been proposed regarding the etiology of chronic ...

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