Treating Paediatric CFS
By Dr David Bell; MD F'AAP; Chief, Dept of Paediatrics, Medina Hospital, New York
Chronic Fatigue Syndrome (CFS) is widely recognised in adults, but it is not as well known that children and adolescents can have the illness. (CFS is a term used in America for ME)
CFS has been found in children as young as aged 5. An Australian study reported 5.5 CFS cases per 100,000 children up to age 9, and 47.9 per 100,000 from ages 10-19. Early practical intervention for paediatric CFS is well within the training and ability of primary care physicians: however, the illness can and often does present differently in children than in adults, and can be difficult to diagnose.
Symptoms: There appear to be 2 onset patterns of paediatric CFS - gradual, or insidious, onset of symptoms, usually in children between 5 and 12 years of age; acute onset of symptoms, more common with cases beginning in adolescence
As in adult CFS, symptoms may include sore throat, joint pain, migraines, irritable bowel syndrome, post-exertion malaise, sleep disorders, photosensitivity, impaired concentration and memory. Symptoms of CFS in young children most often have their onset with headache or irritable bowel syndrome.
The cognitive disturbances in CFS can produce reduced concentration, short-term memory loss and confusion, and may be confused with Attention Deficit Disorder in children. These symptoms may be hard to recognise because children do not have as much experience as adults in judging their own cognitive abilities.
Paediatric CFS patients will often have numerous symptoms at equally severe levels, but the symptoms will migrate. For example, a child may complain of sore throat and headache, followed the next day by lymph node and abdominal pain. By recording the symptoms during office visits, an overall pattern can be established. However, establishing a pattern may be complicated by the fact that children sometimes have difficulty recognising changes in energy, and very young children in particular are unable to verbalise what they are experiencing. Some children with CFS do not perceive themselves as being ill because they have no clear reference for normal health.
Diagnosis: The diagnosis of CFS is entirely clinical: a characteristic pattern of somatic symptoms dominated by unexplained fatigue limiting normal activity. Laboratory testing should be used to exclude other possible causes for the symptoms, but by far the most effective tool to use when CFS is suspected is an activity scale or a daily diary that measures a child's overall normal activity levels.
A child with CFS will have substantially reduced activity levels, but may appear to others to have a normal activity level. For example, a child with CFS may be able to participate in sporting activities at the weekend (i.e. playing in a soccer game), giving the appearance the he/she is healthy. On closer examination, however, the child with CFS who participated in the soccer game would have to rest for the remainder of the day and usually the next day.
School attendance is the most important indicator of both severity and prognosis of paediatric CFS. If the CFS symptoms are mild, the child can make it through a full day of school, perhaps even with gym class, but will have increased fatigue and need to rest more often. Moderate CFS permits part-time school without gym or sports and requires the child to get extra rest every evening.
With severe forms of CFS, school attendance may not be possible, and home tutoring should be used to maintain an appropriate grade level.
Comparing the child's activity levels at weekends and during the summer to their activity during the school week is also important. Children often report that they feel better in the summer, which is often considered an indication of school phobia. However, it may actually be because fewer sustained activities are required.
Measuring activity levels helps to rule out school phobia or depression. Depressed children do not feel overly tired and weak. A child with CFS will be just as inactive at the weekend as during the school week or may actually maintain less activity during unrestricted times.
(thanks to IMEGA)
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