Chronic Fatigue

A diagnosis of chronic fatigue has great appeal. It gives parents and children a socially accepted explanation for long-lasting complaints and some physicians a label for an otherwise baffling set of symptoms.

 In part this is due to do with the nature of the Ebstein-Barr virus, the virus that causes mononucleosis. Most adults, and many infants and children have been infected with this virus at some point in their lives (90%). Assessing these patients is a difficult task. Most have normal physical examinations and laboratory tests, despite testing positive for the virus in the past. It is rapidly becoming apparent that most patients with “chronic fatigue syndrome” do not have an active case of the virus. We do know the Ebstein-Barr virus can cause many illnesses ranging from mononucleosis to a prolonged and intermittent infection can even cause death, in severe cases.

To diagnose severe, chronic EBV infection, I consider: a severe illness lasting more than six months; evidence of involvement of the bones, eyes, lymph glands, liver or lungs. Special laboratory tests may be helpful in confirming the diagnosis. A chronic fatigue syndrome that meets my specific criteria is uncommon in children and adolescents.

Complaints of prolonged fatigue are common among teenagers. Small children rarely complain of “feeling tired,” and even children with chronic disease rarely complain of fatigue. The concerned parent usually observes and reports that the child appears fatigued. Parents say things like, “He has no energy,” or “All she does is lay around the house.” They describe a child who prefers sedentary activities, looks tired or droopy, has no energy, seems bored, doesn’t want to play with friends, and generally shrinks from social contacts. Many children experience periods of lassitude from time to time. But, children who go through protracted and severe periods of chronic fatigue and withdrawal from usual activities may be suffering from a serious depression.

They will need special medical or psychiatric treatment.

Adolescents complain about being fatigued quite frequently. In fact, fatigue is among adolescents most common problems in pediatric practice and one that arouses much concern in parents, particularly in spring, when adolescents suffer from a combination of fatigue and mild depression. Springtime is the season of the greatest school-related stress, before final exams, grades, college acceptance, prom time, and graduation. These symptoms should definitely be called “spring fever.” All the uncertainties of adolescence including identity and sexual crisis, may create spring fever anytime of the year, with fatigue the major complaint. Many of the adolescence who come to my office with complaints of fatigue and no other problems have an emotionally based problem, usually a product of stress and anxiety.

This is a complex problem that may take time to work through. It should be discussed with both parents and child or adolescent.