David S. Bell MD FAAP
77 South Main Street
Paediatric Chronic Fatigue Syndrome: Spectrum Of Illness
Chronic fatigue syndrome (CFS) has been documented to occur in children and adolescents, but there has been ongoing confusion concerning incidence, clinical manifestations, and severity. The majority of paediatricians believe that if CFS exists at all, it is a short lived, perhaps trivial condition, and a manifestation of psychiatric illness. Many paediatricians would argue that CFS should not be diagnosed in children because the diagnosis will "cause" the illness to persist. This underlying assumption concerning the trivial nature of CFS and the minor impact on a child's life are not consistent with natural history of the illness as seen by clinicians.
The assumption of the benign nature of paediatric CFS has resulted in little attention paid to children and adolescents with this illness, and no paediatric diagnostic criteria have been developed. While it is possible that CFS can be mild and resolve completely in some young persons, there is a wide spectrum of illness severity, and severe cases exist. Six case histories of severe paediatric CFS are presented, each of which contradicts a commonly held belief about the illness, including severity, symptomatology and duration of illness. Through case presentations CFS can be seen as a serious, even life threatening illness, one that is not explained by any psychiatric theory. The clinical course can cause severe functional limitation, pain and expose the child or adolescent to significant risks, such as the need for parenteral nutrition. The greatest emotional pain caused by the illness exists through the neglect or denial of both society and the medical profession.
There is an urgent need for increased attention to CFS among young persons. Studies concerning the clinical presentation, natural history, and long term prognosis should be undertaken. Specific diagnostic criteria should be developed, and clinicians should be educated to the possibility that CFS can extend into severe, perhaps lifelong, symptoms.
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