Difficulty in Diagnosing Chronic Fatigue Syndrome in Children and Adolescents Examined

A community-based screening of over 12,000 households was conducted to determine the prevalence of fatigue and CFS-like symptoms in a sample of 5- to 7-year-olds. Results indicated that over 4% of the sample were fatigued and that 2.05% were diagnosed with CFS-like symptoms. Adolescents had a slightly higher rate of CFS-like symptoms (2.91%) than did pre-pubescent children (1.96%). Those with CFS-like symptoms were almost evenly divided between male (47.5%) and female (52.5%). Youngsters of Latino origin had the highest representation in the CFS-like group.

The screening was conducted to help better pinpoint how to accurately diagnose CFS in children and adolescents. In the case of children, it is the parent’s job to communicate their child’s symptoms to their doctor. In some cases, rather than saying their child is “fatigued,” a parent might say that the child is always sleepy, grumpy, distracted, or can’t keep up with other children in school or at play. Adolescents, on the other hand, are more like adults in terms of symptoms and consequences of the symptom complex than are the younger children. The challenge with adolescents, however, is to differentiate CFS from illnesses that simply occur during this time from those that virtually only occur at this time of great change in the life. The latter may be considered to include school avoidance, stress due to peer or personal pressure, depression and living within a dysfunctional family.

The symptoms presented in children are generally described as similar to those of adults; however, studies have shown that children and adolescents have a greater incidence of gradual onset of symptoms and a more equal gender distribution than adults. Concern has been raised that the criteria currently diagnosed CFS in adults may not be appropriate for diagnosing children and adolescents. In addition, it is more difficult to diagnose children under the age of 10 because they may have difficulty communicating the extent and severity of their fatigue and related symptoms.

A prominent difference between adults and children with CFS is that children more commonly report symptoms such as dizziness, light-headedness, abdominal pain, rash, fever, and chills. The illness’ relapsing and remitting pattern is a primary reason for frequent misdiagnosis of pediatric CFS as a “behavioral” or “emotional” disorder, and in particular as school phobia.

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