Chronic Fatigue In Teenagers

Has your teenager complained about being extremely tired lately? Has your teen increased their sleep and you notice they are still tired? Your teen might be dealing with chronic fatigue. Chronic fatigue is a condition characterized by continued tiredness that is not relieved by rest, can be worsened by exertion and is not directly caused by any other medical conditions. The exact cause of chronic fatigue is unknown. There are a variety of reasons for chronic fatigue, and medical conditions that need to be ruled out including but not confined to anemia, hypothyroidism, infections, malnutrition and depression. There are many other causes but these are more common ones to consider. Once primary medical conditions have been excluded a common factor contributing to unexplained, chronic fatigue is physical and cognitive deconditioning; not going to school, not being on a regular schedule, sleeping too much, decreasing the amount of physical activity or not getting any physical activity. This ends up worsening the fatigue: the less they do the less they can do. Chronic fatigue can occur at any age. There have been a variety infections that have been known to cause tiredness, however there is not one specific viral or infectious agent that causes chronic fatigue. It’s known that after a Epstein–Barr virus (the virus that commonly causes infectious mononucleosis) infection, a teenager can be fatigued for weeks and sometimes longer as part of the normal recovery process. However, it’s important for the physician and the family to help get the teen back on a schedule as soon as possible after an infection so as not to prolong the recovery longer than indicated. The main symptom of chronic fatigue is extreme tiredness which has been going on for much longer than can be medically explained (weeks to months). In this blog we are deliberately avoiding the term chronic fatigue syndrome, rather referring to teens with fatigue that has lasted longer than expected. In fact, the Institute of Medicine in 2015 recommended not using the term “chronic fatigue syndrome” to refer to the condition described in this blog: fatigue that results in a substantial reduction in or the impairment in the ability to engage in per-illness activities and persists for months. They have recommended that this disorder be referred to as “systemic exertional intolerance disease” (SEID). This captures the fact that exertion of any sort – physical, cognitive, emotional- can adversely affect these patients in many organ systems and aspects of their lives. Other associated symptoms can include one or more of the following:

• Feeling extremely tired for more than 24 hours after exercise that would normally be considered easy
• Feeling unrefreshed after sleeping for a proper amount of time
• Forgetfulness
• Concentration problems
• Confusion
• Dizziness, nausea in the upright position
• Joint pain but no swelling or redness
• Headaches that differ from those you have had in the past
• Irritability
• Mild fever (101 degrees For less)
• Muscle aches (myalgias)
• Muscle weakness, all over or multiple locations, not explained by any known disorder
• Sore throat
• Sore lymph nodes in the neck or under the arms

The goal when diagnosing chronic fatigue is to make sure other diagnosis have been ruled out such as the ones discussed above. However the Centers for Disease Control suggests a limited set of tests be done if the physical examination is otherwise normal.  Currently, there is no one unifying explanation for what cause chronic fatigue of a non-medical etiology, and therefore there is no medicine, dietary supplement or cure for chronic fatigue as a whole. However, what is known is that the fatigue can be improved by reversing the deconditioning process by making sure they are getting enough physical activity, attending school and improving their sleep schedule. These interventions can be done gradually, for example over the course of weeks. Patients with chronic fatigue are encouraged to maintain active social lives and do regular physical exercise. A specific aerobic conditioning program, starting slowly and building each week, is reasonable. Counseling can also play a role in coping with the illness and can involve the individual and the family. One question is how long to wait before starting to treat the symptoms. For children and adolescents the duration of symptoms to make the diagnosis of SEID is the same as adults, i.e. 6 months, however treatment of the symptoms can start at any time after the onset of the fatigue. In fact, I suggest it starts at weeks rather than months after onset. For more information about Texas Children’s Adolescent Medicine program, please visit here.