As in adults, chronic fatigue syndrome (CFS) in children manifests as a complex illness characterized by incapacitating fatigue, neurological problems and a constellation of symptoms that can resemble many other disorders (including mononucleosis, childhood migraine syndrome and Lyme disease).
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 majority of children, particularly adolescents, have an acute onset of symptoms that marks the beginning of CFS. This is characterized by the sudden appearance of symptoms within a few days to weeks, usually with a flu-like or mononucleosis-like illness in a child who had previously been healthy.
The gradual presentation of CFS seems to occur more often in younger (pre-adolescent) children. It is defined by the appearance of symptoms over several months or longer, or by mild symptoms suggestive of CFS (frequent sore throats, headaches or joint pains, relative inactivity, sleeping more than other children of the same age), prior to an acute episode.
It is often difficult for children who experience a gradual onset to describe their degree of fatigue or cognitive difficulties because they don't recall a time period without them. Interestingly, these children may not perceive themselves as being ill, most likely because they have been growing up with their symptoms and have no clear reference to normal health.
Diagnosing Chronic Fatigue Syndrome In Children
The first step in properly treating children with CFS is making the diagnosis. Failure to establish the diagnosis and lack of cooperation between professionals may lead to inaccurate impressions that the child is malingering or "faking." This may result in isolation, insecurity, sense of failure, family stress and even legal action against the family by school authorities. Further, an unresolved diagnosis may leave the child with uncertainty as to whether he or she is really experiencing the symptoms, or whether they are "all in the mind," as skeptics claim.
The illness' relapsing and remitting pattern is a primary reason for frequent misdiagnosis of pediatric CFS as a behavioral or emotional disorder, in particular school phobia.
Because children don't have as much experience with and are less sure of their cognitive abilities, neurological symptoms may appear as progressive school difficulties. Adults have a clear perception of their mental abilities, so memory loss and concentration difficulties are easily recognized.
While the physical symptoms may be similar in children and adults, differences in defining the symptoms can make it more difficult to identify CFS in children. Parents and children may use different words to describe the child's symptoms than those used to describe an adult's illness. Consulting with a knowledgeable physician who listens carefully and asks appropriate questions is essential in determining an accurate diagnosis.
Treatment For Children With Chronic Fatigue Syndrome
Treatment for children varies little from that for adults and it must be carefully tailored to meet the needs of each patient. Lifestyle changes, including increased rest, reduced stress, dietary restrictions, nutritional supplementation and light exercise (such as walking) are frequently recommended.
Cooperation with health professionals and the child's school teachers is essential in ensuring a positive educational experience and a normal social development, despite the seriousness of this debilitating disease. Children with CFS must often work harder to maintain the same grades they were earning prior to becoming ill, while having to miss a good deal of school. A reduced school schedule supplemented by home tutoring can help in this regard.
