Risk Factors for Persistent Fatigue with Significant School Absence in Children and Adolescents – Source: Pediatrics, July 2009

Objective: To assess children and adolescents with severe fatigue who are referred to pediatricians and to examine whether factors can be identified at their first visit that predict worse outcomes at 1 year.

Methods: Ninety-one patients, aged 8 to 18 years completed questionnaires about sleep, somatic symptoms, physical activity, and fatigue. They were reassessed 12 months later. Measurements at baseline and outcome were analyzed by using univariable logistic regression with persistent, severe fatigue (yes/no) and persistent school absence (yes/no) as dependent variables and baseline scores as independent variables.


After 12 months, 50.6% of the children and adolescents showed improvement; 29.1% had persistent fatigue, and 20.3% had persistent fatigue with significant school absence.

Factors associated with the poorest outcome were:

• Sleep problems (odds ratio [OR]: 1.4 [95% confidence interval (CI): 1.1–1.8]), [Note: an odds ratio of 1.0 would mean no greater risk than others; the OR of 1.4 indicates a 40% greater risk; 2.0 a 100% greater risk, and so on.]

• Initial fatigue score (OR: 1.1 [95% CI: 1.0–1.2]),

• Somatic complaints such as hot and cold spells (OR: 1.9 [95% CI: 1.2–3.0]),

• Blurred vision (OR: 2.1 [95% CI: 1.1–4.0]),

• Pain in arms and legs (OR: 2.0 [95% CI: 1.0–3.2]),

• Back pain (OR: 1.8 [95% CI: 1.0–3.2]),

• Constipation (OR: 1.7 [95% CI: 1.0–2.7]),

• And memory deficits (OR: 1.8 [95% CI: 1.0–3.2]).

Resolved fatigue was associated with male gender (OR: 5.0 [95% CI: 1.6–15.5]) and a physically active lifestyle (OR: 1.3 [95% CI: 1.1–1.5]).

Assessment of predictive factors at the first visit enables the pediatrician to identify those patients with severe fatigue who are at risk of a poor outcome.
• Female gender,
• Poor sleep quality,
• Physically inactive lifestyle,
• And specific somatic complaints…
…were important predictive factors.

Source: Pediatrics, July 2009;124(1) pp e89-95. PMID: 19564274, by Bakker RJ, van de Putte EM, Kuis W, Sinnema G. Department of Pediatrics, Antonius Ziekenhuis, Sneek, Netherlands; Departments of Pediatrics & Pediatric Psychology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, Netherlands. [E-mail: robhelbz@telfort.nl]

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