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Quick reference medical handouts used by Pediatric offices

A tired child may not be sick

Hardly a week goes by that a pediatrician does not evaluate a child because of chronic fatigue. Parents begin to worry because their child appears tired, "lays around the house a lot," "has no pep," and is "sleeping most of the time." The youngster withdraws socially from friends and no longer participates in activities they previously enjoyed. A comment from a grandparent or the child’s teacher often triggers even more parental anxiety and a phone call to their child’s pediatrician. Parents are convinced that their youngster has a serious medical problem. On the other hand, the child often disagrees and frequently questions the need for the doctor’s visit. While unexplained weariness can be a symptom for a variety of diseases, the most common cause of chronic fatigue in children is lack of sleep, "burning the candle at both ends," or emotional stress. Nonetheless, it is still a good idea to have the tired child checked for a medical condition. Of the ailments causing fatigue, probably the most common is a chronic infection, such as pneumonia, tuberculosis, infectious mononucleosis or hepatitis. Tiredness can also be seen in the allergic child with hay fever, sinusitis, or asthma. Certain hormonal disorders, such as diabetes mellitus and hypothyroidism ("low thyroid") will make a child listless. Anemia ("low blood"), while often suspected, rarely causes fatigue until the blood count is quite low. A very important cause of chronic fatigue is teenage alcoholism and drug abuse. While often denied by parents ("not my child!"), these two conditions are far more common than most parents would like to believe. Most medical disorders will be discovered during the physical examination and, although the child "looks well," the physician might order blood and urine tests to search for a medical cause. Interestingly, the impression that the child "looks well" during the checkup is often a good indication of the youngster’s overall health. More often than not, the child’s examination and laboratory tests are completely normal. This brings the parents and pediatrician back to square one - a tired child with worried parents! Most of these children, particularly teenagers, will fall into one of two groups. The first is that they are simply during too much ("burning the candle at both ends"). The youngster is up early in the morning to catch the school bus, attends honor classes, runs cross-country, has a part-time weekend job, and keeps a hectic schedule until late in the day. At home, all the parents see is a tired, worn out child! The obvious cure for this cause of fatigue is more rest and less activity. Stress is zapping the energy of the second group of tired children. Since youngsters spend most of their time in one of three spheres (school, with family, or with friends), a problem in any of these areas can cause a healthy child to become withdrawn, fatigued, and tired. For example, a child may continue to get good grades in school but become anxious when they feel unable to meet parental or teacher expectations. A youngster under pressure to perform in sports and the overachiever are particularly vulnerable to stress that makes them tired and weak. At home, a family crisis (financial, marital, or medical) beyond the child’s control often causes fatigue as a manifestation of the youngster’s helplessness. These youngsters are usually tired when they wake up in the morning, never feel right during the day, and seem to spend a lot of time in their room. They may also be short on sleep, exhibit borderline eating habits, and have a variety of other symptoms, such as headache, stomachache, and chest pains. The fatigue often appears during times of school stress (exam time), extracurricular activity, sports, or social events. Interestingly, fatigue from emotional causes can also result from a confirmed physical illness. For example, an adolescent who has been sick with infectious mononucleosis and missed school may become anxious and remain tired for months after the medical problem has resolved. The child with unexplained fatigue benefits from parental understanding and warm attention.. The tired youngster should be reassured that they are otherwise healthy and that everyone experiences fatigue from time to time. Since school is vital to a child’s development, the tired youngster presents a special challenge to educators. Schools must be willing to allow flexibility in programming and scheduling so that the fatigued child does not fall behind in their studies. Suggestions should also be given to help the youngster modify their daily routine. Parents should eliminate any possible stresses and suggest modifications and changes in lifestyle. Perhaps fatigue in some kids is a product of today’s society. Many parents feel that their children must be constantly entertained. Younger children are enrolled in exercise groups and swimming lessons. On non-swimming days, it is gymnastics, music class and play groups. Dance classes, music lessons, soccer teams or little league occupy the free time of older children. High school students become involved in school clubs, art instruction, computer courses, weight training, and competitive sports. Summer vacations become filled with sports camps, drama camps, computer camps, and space camps. And there is always television and video games. While parental motives are well intentioned, many of today’s children cannot amuse themselves or be alone. So when they come home from school with nothing to do, they are tired and bored. Fatigue is a common symptom during childhood. While most youngsters with long standing fatigue have an emotionally related problem, it is important to have a physician exclude a medical cause. A good rule of thumb is for parents to answer the question "who requested the visit?" If the child wanted to see the physician, then there is a good chance a medical cause will be found. If the parents are more worried than the child, a physical cause is less likely. Remember, all children, like adults, normally go through periods of fatigue and tiredness in their lifetime, but these instances are brief and usually self-limited.


As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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