Wednesday, March 3, 2010

Chronic Fatigue Syndrome and Children

Chronic fatigue syndrome is rare in children with estimates of approximately 0.05% have this diagnosis. The day to day lives of children with this diagnosis are greatly affected. Pediatric therapists should be aware of this disorder and how it effects the activities of daily living of children.

Chronic fatigue syndrome (CFS) is characterized by: debilitating fatigue, exhaustion, symptoms present for 50% of the time for more than 3 months, flu like symptoms, muscle/ joint pain, inability to concentrate, sleep disturbances and changes in mental and physical functioning. The average age of onset is between 11-15 years of age with girls more affected than boys. Based on these symptoms, children may have a high rate of absenteeism from school. Due to inactivity, the children with CFS can lose muscle mass, muscle strength, lower basal metabolic rate and more. These are areas that an occupational and physical therapist can address.

Once a diagnosis is made of CFS, the next step is to manage the symptoms. A good rapport should be established between the child, the family and the school in order to address all issues. Explain the disorder and how many of the symptoms are a result of a spiraling effect of inactivity and rest. When an exercise program is warranted, here are several tips:

1. Educate the child, family and school on the importance of exercise and how it can help combat the symptoms of chronic fatigue syndrome.

2. Get the child involved in establishing the exercise program. What type of exercises do they enjoy?

3. Begin the exercise program slowly avoiding large changes in duration and frequency of exercise. Gradually increase the duration and frequency of sessions.

4. Ask the child to keep a record of the exercises to encourage ownership and independence with the exercise program.

5. Provide verbal reminders to perform stretching and strengthening exercises slowly and controlled.

6. Educate the child and the family on mild muscle soreness or delayed onset muscle soreness. Explain to them that these are common symptoms when you return to normal physical activity levels.

7. Educate the child and family on returning to normal eating and sleeping patterns.

8. When a child has been out of school for a long period of time, returning to school may have to be done on a gradual basis.

Chronic fatigue syndrome needs to be addressed with open lines of communication throughout the medical team, family and school. Occupational and physical therapist can play a significant role in getting children with chronic fatigue syndrome back to doing what they do best, learning, socializing and playing.

Reference: Wright, Barry, Partridge, Ian, Williams, Christine Management of chronic fatigue syndrome in children Adv Psychiatr Treat 2000 6: 145-152

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