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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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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.
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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
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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 ...