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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 childs pediatrician.
Please read our full disclaimer.