Prolonged unexplained fatigue in paediatrics

Abstract

Prolonged Unexplained Fatigue in Paediatrics. Fatigue, as the result of mental or physical exertion, will disappear after rest, drinks and food. Fatigue as a symptom of illness will recover with the recovering of the illness. But when fatigue is ongoing for a long time, and not the result of exertion or a symptom of an illness, it will become a condition with a serious risk for the educational and social development of children and adolescents. This dissertation presents the results of research in children and adolescents (age 8-18 years), who were referred by their General Practitioner to the Paediatrician. Half of the patients recovered with usual care (i.e. reassurance and advices to visit school and to take part of social activities as much as possible), but the other half the same subjective fatigue severity with the same disabilities one year later and even two years later half of the young patients with CFS was still suffering in the same degree. That means that, notwithstanding all additional kinds of regular and alternative treatments, about one quarter of fatigued youngsters, who visited the paediatrician for the first time developed, a life with serious restrictions, without a medical explanation. These young patients stand for a great challenge to the paediatrician, when they visit him in the early stage of fatigue. The characteristics of the patients repudiate the opinion that ongoing fatigue in young people are related to today’s overloaded life style, late bed times and unhealthy habits. It seems the opposite, the patients participated less in social activities, in spite of good relationships and friendships. We found indications that family dynamics and/or genetic factors increased the vulnerability for fatigue, that life events might be provoking factors and that the social environment was little helpful in resistance. We discovered risk and protective factors for an unfavourable development in the beginning of fatigue. Risk factors were somatic complaints such as blurred vision, hot/ cold spells, constipation, memory deficits, pain in back and extremities, the degree of subjective fatigue measured by the CIS-20, and female gender. Protective was a physically active life style before the onset of fatigue. We found a significant different effect between sport activities in sport clubs and self regulated sports activities. Remarkable was the finding that three patients with the most self regulated sports activities had the worst outcome one year later. The risk and protective factors can be directive for customizing treatment for the individual patient, because the group of fatigued patients is heterogeneous. We explored, on top of the usual care, the usefulness of a video film intervention aiming at the education about the diagnosis CFS and the modelling of coping behaviour. The intervention with that particular film had an adverse effect. Compared with patients who received only usual care, patients who received the film in addition, were equally fatigued but had more school absence and were less motivated one year later. We interpreted the adverse effects as the result of the double message of the film. It is possible that patients particularly picked up the first massage (i.e. fatigue complaints may be the result of a well-known condition: CFS)as an explanation and legitimization of their complaints, but the second message(i.e. how to cope successfully with debilitating fatigue and unhelpful thoughts) did not get across. The conclusion is a serious warning against assigning the label of CFS too early to fatigued children and adolescents.