Case control study of chronic fatigue in pediatric patients
February 10, 1995
OBJECTIVE. To determine the demographic characteristics, medical
features, psychological profile, and natural history of
children with chronic fatigue.
DESIGN. Case control study.
SETTING. Pediatric Infectious Diseases Clinic of Kosair
Children's Hospital, 1990 to 1992.
patients referred for persistent fatigue were evaluated.
Twenty patients participated in a psychological study; 20
healthy controls of similar age and gender were recruited from
community pediatric practices and 20 matched depressed
controls were recruited from university psychiatry services
(subjects were treated as groups in the analyses).
Demographic data were obtained for all referred patients.
Those with fatigue for at least 2 months and no alternative
diagnosis received a detailed history, physical, and battery
of laboratory tests (complete blood count, sedimentation rate,
chemistry panel, chest X-ray thyroid stimulating hormone,
thyroxine, anti-nuclear antibodies, urinalysis,
immunoglobulins, and Epstein-Barr virus (EBV), toxoplasma, and
cytomegalovirus serologies). Psychological study participants
completed the following: background structured interview;
Kaufman Brief Intelligence Test; Children's Depression
Inventory; Child Behavior Checklist; Youth Self Report;
Diagnostic Interview for Children and Adolescents-Revised;
mail-in follow-up survey.
RESULTS. The median age of fatigue
patients was 14.3 years; 60% were female, 96% white, and 87%
from the mid/upper socioeconomic status (SES). Fatigue
patients were demographically similar to 21 patients referred
for infectious mononucleosis (IM) but were older than other
clinic patients (P < .0001). White race (P = .0568) and
mid/upper SES (P = .0403) were over-represented among fatigue
patients compared to patients referred for other diagnoses. Of
36 patients meeting criteria for further study, 5 had an
IM-like illness including evidence of recent EBV infection.
For the remaining 31 patients, clinical and laboratory
evaluations were unrevealing. Psychological study subjects
reported marked declines in quality-of-life and scored high on
measures of internalizing, withdrawal, and social isolation.
Nine met diagnostic criteria for depression, although
depressive symptoms were not as prominent as those reported by
depressed controls. Fatigue subjects scored higher on
somatization than both control groups. The follow-up survey
indicated symptomatic improvement in most patients.
CONCLUSIONS. Chronic fatigue was a common reason for
referral, with over-representation of white children from
mid/upper SES. After exclusion of EBV-associated IM, screening
laboratory tests were not helpful in establishing specific
organic diagnoses. Whereas the natural history was favorable,
chronic fatigue resulted in major quality-of-life changes and
was associated with significant levels of psychosocial
IMPLICATIONS. Psychological evaluation is warranted
in these patients, as some may have treatable psychological
conditions. Given the absence of proved medical therapies,
psychosocial interventions to improve quality-of-life should
Carter BD, Edwards JF, Kronenberger WG, Michalczyk L, Marshall GS
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