Risk Factors for Persistent Fatigue With Significant School Absence in Children and Adolescents

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. RESULTS: 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]), 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]). CONCLUSIONS: 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.

[1]  R. Viner,et al.  Longitudinal risk factors for persistent fatigue in adolescents. , 2008, Archives of pediatrics & adolescent medicine.

[2]  M. Hotopf,et al.  Etiology of Chronic Fatigue Syndrome: Testing Popular Hypotheses Using a National Birth Cohort Study , 2008, Psychosomatic medicine.

[3]  A. Kavelaars,et al.  Predictors of Persistent and New-onset Fatigue in Adolescent Girls , 2008, Pediatrics.

[4]  W. Rief,et al.  The relationship between chronic fatigue and somatization syndrome: a general population survey. , 2007, Journal of psychosomatic research.

[5]  J. Saul,et al.  Abnormal Thermoregulatory Responses in Adolescents With Chronic Fatigue Syndrome: Relation to Clinical Symptoms , 2007, Pediatrics.

[6]  J. Saul,et al.  Sympathetic predominance of cardiovascular regulation during mild orthostatic stress in adolescents with chronic fatigue , 2007, Clinical physiology and functional imaging.

[7]  M. Hotopf,et al.  Incidence, Prognosis, and Risk Factors for Fatigue and Chronic Fatigue Syndrome in Adolescents: A Prospective Community Study , 2007, Pediatrics.

[8]  R. Engelbert,et al.  How fatigue is related to other somatic symptoms , 2006, Archives of Disease in Childhood.

[9]  A. Kavelaars,et al.  Severe Fatigue in Adolescents: A Common Phenomenon? , 2006, Pediatrics.

[10]  A. Fletcher,et al.  A Follow-up Study of Chronic Fatigue Syndrome in Children and Adolescents: Symptom Persistence and School Absenteeism , 2006, Clinical child psychology and psychiatry.

[11]  Gijs Bleijenberg,et al.  Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomised controlled trial , 2004, BMJ : British Medical Journal.

[12]  M. Hotopf,et al.  Childhood predictors of self reported chronic fatigue syndrome/myalgic encephalomyelitis in adults: national birth cohort study , 2004, BMJ : British Medical Journal.

[13]  H. Moldofsky,et al.  Sleep assessment in a population-based study of chronic fatigue syndrome , 2004, BMC neurology.

[14]  L. Rangel,et al.  Impairment and coping in children and adolescents with chronic fatigue syndrome: a comparative study with other paediatric disorders. , 2004, Journal of child psychology and psychiatry, and allied disciplines.

[15]  S. Wessely,et al.  Chronic fatigue syndrome in children: a cross sectional survey , 2003, Archives of disease in childhood.

[16]  P. Muris,et al.  The Children's Somatization Inventory: further evidence for its reliability and validity in a pediatric and a community sample of Dutch children and adolescents. , 2003, Journal of pediatric psychology.

[17]  M. Smith,et al.  Comparative study of anxiety, depression, somatization, functional disability, and illness attribution in adolescents with chronic fatigue or migraine. , 2003, Pediatrics.

[18]  Y. Kajimoto,et al.  Impaired postural cerebral hemodynamics in young patients with chronic fatigue with and without orthostatic intolerance. , 2002, The Journal of pediatrics.

[19]  A. Vingerhoets Assessment in behavioural medicine , 2001 .

[20]  J. Stewart,et al.  Orthostatic Intolerance in Adolescent Chronic Fatigue Syndrome , 1999, Pediatrics.

[21]  M. Sharpe,et al.  Do patients with "pure" chronic fatigue syndrome (neurasthenia) have abnormal sleep? , 1997, Psychosomatic medicine.

[22]  James M Barker,et al.  A case-control study to assess possible triggers and cofactors in chronic fatigue syndrome. , 1996, The American journal of medicine.

[23]  Susan K. Johnson,et al.  Assessing Somatization Disorder in the Chronic Fatigue Syndrome , 1996, Psychosomatic medicine.

[24]  Ian Hickie,et al.  The Chronic Fatigue Syndrome: A Comprehensive Approach to Its Definition and Study , 1994, Annals of Internal Medicine.