Fatigue
Fatigue: Excerpt from The Diagnostic Approach to Symptoms and Signs in Pediatrics
Defined as lack of energy for activitiesand decreased endurance for them.
Principal Causes of Fatigue
- Physiologiccauses
- Pathologic causes
- Anemia
- Infection
- Chronic disease
- Allergic disease
- Chronic fatigue syndrome
- Drugs
- Psychologic
Clinical Features and Diagnosis
Physiologic Causes
Children who lack sleep and rest, have decreasedcaloric intake, and engage in strenuous or prolonged exercise arelikely to experience fatigue.
Pathologic Causes
Anemia
Any typeof anemia can produce fatigue.Pallor is usually evident with moderate-to-severeanemia.CBC should be performed as screeningtest. Infection
Any acute or chronic infection can producefatigue. Common infections that are often associated with prolongedor severe fatigue include infectious mononucleosis, influenza, hepatitisA, tuberculosis, and endocarditis.
Chronic Disease
Fatigue often occurs with cardiac disease(cardiac failure, cyanotic congenital heart disease, pulmonary vasculardisease), pulmonary disease (asthma, cystic fibrosis), chronic renaldisease, inflammatory bowel disease, chronic liver disease, collagenvascular disease, endocrine disorders (hypothyroidism, hyperthyroidism,adrenal insufficiency), muscle disorders that cause weakness, malnutrition,and malignancy.
Allergic Disease
Children with allergic rhinitis (seasonalor perennial) or asthma often experience fatigue, until their symptomsare relieved.
Chronic Fatigue Syndrome
Revisedcase definition of this syndrome was proposed by Fukada et al. (1994).Characterized by unexplained persistentor relapsing fatigue for >6 mos that seriously interfereswith normal activities. Not related to ongoing exertion nor is itsubstantially relieved by rest.≥4 of the following symptoms musthave persisted or recurred during 6-mo period and must not havepredated fatigue: sore throat; tender cervical or axillary adenopathy;muscle pain; pain in multiple joints without swelling or redness;headaches of new type, pattern, or severity; awakening from sleepstill tired; malaise lasting >24 hrs after exertion; andimpaired short-term memory or concentration.Diagnosis is clinical. Drugs
Fatigue is common side effect of many drugs,including antihistamines, anticonvulsants, tranquilizers, and opiates.
Psychologic
Psychologicdisturbances (e.g., anxiety, depression, grief reaction, schoolphobia, or somatization disorder) can cause fatigue.History and clinical observation areusually diagnostic. Diagnostic Approach
When childcomplains of fatigue, history and physical exam are often diagnostic.CBC can screen for anemia.Monospot test can confirm diagnosisof infectious mononucleosis, but if result is negative, Epstein-Barrvirus IgG and IgM antibodies can be performed.Psychosocial history is most importantdiagnostic tool for psychologic problems.If diagnosis remains uncertain, initialscreening investigations for chronic disease include sedimentationrate; stool guaiac; serum electrolytes, glucose, creatinine, aminotransferases;blood urea nitrogen; UA; chest radiography; and intermediate-strengthtuberculin skin test.Other investigations depend on suspecteddiagnosis and results of these tests. References
- Behrman RE, et al., eds. Nelson textbookof pediatrics, 16th ed. Philadelphia: WB Saunders, 2000.
- Fukada K, et al., and the International Chronic FatigueStudy Group. The chronic disease syndrome: a comprehensive approachto its definition and study. Ann Intern Med 1994;121:953–959.
- Green M. Pediatric diagnosis, 6th ed. Philadelphia:WB Saunders, 1998.
- Illingworth RS. Common symptoms of disease in children,7th ed. Oxford: Blackwell Scientific, 1982.
- Marshall GS, Carter BD. Chronic fatigue syndrome. In:Long SS, et al., eds. The principles and practice of pediatric infectiousdiseases. New York: Churchill Livingstone, 1997:1118–1128.
- Tunnessen WW Jr. Signs and symptoms in pediatrics,3rd ed. Philadelphia: Lippincott, Williams & Wilkins, 1999.
Book Source Details
- Book Title: The Diagnostic Approach to Symptoms and Signs in Pediatrics
- Author(s): Paul S. Bellet
- Year of Publication: 2006
- Copyright Details: The Diagnostic Approach to Symptoms and Signs in Pediatrics, Copyright © 2006 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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