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Chronic Fatigue Syndrome: Not a Diagnosis in Children



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Am Fam Physician. 1998 Mar 1;57(5):1129-1130.

Although chronic fatigue syndrome has no known diagnostic markers, a standardized set of diagnostic criteria has been proposed by the International Chronic Fatigue Syndrome Study Group, the Centers for Disease Control and Prevention, and the National Institutes of Health (see the accompanying table). Plioplys reviews the reasons that this disorder should not be diagnosed in children and adolescents.

Revised Criteria for the Diagnosis of Chronic Fatigue Syndrome*

Major criteria

1. Unexplained, persistent or relapsing chronic fatigue that is of new or definite onset (not lifelong)

2. Fatigue is not due to ongoing exertion.

3. Fatigue is not substantially alleviated by rest.

4. Fatigue results in substantial reduction in previous levels of occupational, educational, social or personal activities.

Minor criteria

1. Self-reported impairment in short-term memory or concentration severe enough to cause substantial reduction in previous levels of occupational, educational, social or personal activities

2. Sore throat

3. Tender cervical or axillary lymph nodes

4. Muscle pain

5. Multiple joint pain without joint swelling or redness

6. Headaches of a new type, pattern or severity

7. Unrefreshing sleep

8. Postexertional malaise lasting more than 24 hours


*—Criteria were developed by the Centers for Disease Control and Prevention, the National Institutes of Health and the International Chronic Fatigue Syndrome Study Group. A case of chronic fatigue syndrome must fulfill all the major criteria, plus four or more of the minor criteria. Each minor criterion must have persisted or recurred during six or more consecutive months of illness and must not have predated the fatigue. A patient who does not fully meet the criteria for chronic fatigue syndrome may be diagnosed as having idiopathic chronic fatigue.

Reprinted with permission from Plioplys AV. Chronic fatigue syndrome should not be diagnosed in children. Pediatrics 1997;100:270-1.

Revised Criteria for the Diagnosis of Chronic Fatigue Syndrome*

View Table

Revised Criteria for the Diagnosis of Chronic Fatigue Syndrome*

Major criteria

1. Unexplained, persistent or relapsing chronic fatigue that is of new or definite onset (not lifelong)

2. Fatigue is not due to ongoing exertion.

3. Fatigue is not substantially alleviated by rest.

4. Fatigue results in substantial reduction in previous levels of occupational, educational, social or personal activities.

Minor criteria

1. Self-reported impairment in short-term memory or concentration severe enough to cause substantial reduction in previous levels of occupational, educational, social or personal activities

2. Sore throat

3. Tender cervical or axillary lymph nodes

4. Muscle pain

5. Multiple joint pain without joint swelling or redness

6. Headaches of a new type, pattern or severity

7. Unrefreshing sleep

8. Postexertional malaise lasting more than 24 hours


*—Criteria were developed by the Centers for Disease Control and Prevention, the National Institutes of Health and the International Chronic Fatigue Syndrome Study Group. A case of chronic fatigue syndrome must fulfill all the major criteria, plus four or more of the minor criteria. Each minor criterion must have persisted or recurred during six or more consecutive months of illness and must not have predated the fatigue. A patient who does not fully meet the criteria for chronic fatigue syndrome may be diagnosed as having idiopathic chronic fatigue.

Reprinted with permission from Plioplys AV. Chronic fatigue syndrome should not be diagnosed in children. Pediatrics 1997;100:270-1.

Fatigue-producing diseases are more common in children and adolescents than in adults. Among the illnesses that should be excluded in children who present with fatigue are central nervous system disorders (including degenerative illnesses and space-occupying lesions), infectious diseases, myopathies, neuropathies and mitochondrial disorders. Psychiatric disorders must also be considered. Depression, anxiety and somatization are most likely, but the possibility of school phobia and family dysfunction should also be considered.

The author emphasizes that the problems involved with diagnosing chronic fatigue syndrome in children are numerous. The most important problem may be that a diagnosis of chronic fatigue syndrome may prevent recognition of a condition that may be treatable (chronic fatigue syndrome is not treatable). Also, if chronic fatigue syndrome is diagnosed after a “standard” medical work-up, rare conditions may be overlooked if the diagnostic work-up is stopped too soon. Psychologic problems may be neglected if chronic fatigue syndrome is diagnosed in children and adolescents and, finally, a diagnosis of chronic fatigue syndrome may promote a “disabled” mindset in the patient.

The author stresses that the internationally developed guidelines for chronic fatigue syndrome should not be applied to children, and that chronic fatigue syndrome should not be diagnosed in these patients.

Plioplys AV. Chronic fatigue syndrome should not be diagnosed in children. Pediatrics. 1997;100:270–1.


Copyright © 1998 by the American Academy of Family Physicians.
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