What is the most common cause of fatigue in children?

Most Common Causes of Fatigue in Children

Sleep disturbances are the most common cause of fatigue in children, followed by psychiatric issues such as depression and anxiety, and various medical conditions including anemia and infection. 1

Primary Causes of Fatigue in Children

Sleep-Related Issues

• Sleep disorders including insomnia and restless sleep are highly prevalent and significantly contribute to fatigue in children 1
• Obstructive or central sleep apnea should be considered in children with persistent fatigue, especially when accompanied by snoring or disrupted nighttime breathing 1
• Poor sleep quality is a strong predictor of persistent fatigue in pediatric populations 2

Psychiatric/Psychological Factors

• Anxiety and depression are frequently reported predictors of fatigue in children 3
• Mood disorders are present in at least half of children with chronic fatigue 4
• Disturbed family relationships can significantly contribute to fatigue symptoms 3

Physical Activity Patterns

• Physically inactive lifestyle is strongly associated with increased fatigue 2
• Children who maintain higher levels of physical activity report less fatigue 5
• Male gender and physically active lifestyle are associated with better resolution of fatigue symptoms 2

Medical Conditions

• Infections are commonly reported as triggers for fatigue in children 4
• Inflammatory conditions like inflammatory bowel disease can cause significant fatigue beyond just active disease 3
• Anemia and nutritional deficiencies can contribute to fatigue through reduced oxygen delivery 6
• Physical disabilities are associated with high levels of fatigue comparable to pediatric cancer patients 5

Risk Factors for Persistent Fatigue

Demographic Factors

• Female gender is associated with higher risk of persistent fatigue 2
• Low socioeconomic status correlates with increased fatigue symptoms 5

Somatic Symptoms

• Specific somatic complaints that predict persistent fatigue include:
  • Hot and cold spells 2
  • Blurred vision 2
  • Pain in arms and legs 2
  • Back pain 2
  • Constipation 2
  • Memory deficits 2

Evaluation Approach

Initial Assessment

• Evaluate sleep patterns and quality, including bedtime routines and sleep environment 1
• Screen for psychiatric conditions, particularly anxiety and depression 3
• Assess physical activity levels and patterns 2, 5
• Consider polysomnography (formal sleep study) when sleep disorders are suspected 1

Medical Workup

• Investigate potential underlying medical conditions:
  • Complete blood count to assess for anemia 6
  • Evaluation for infectious causes 4
  • Assessment of nutritional status 6
  • Consider inflammatory markers when appropriate 3

Management Considerations

Sleep Optimization

• Implement good sleep hygiene and consistent bedtime routines 1
• Create appropriate sleep environments 1
• Consider adjunctive strategies such as melatonin when appropriate 1

Physical Activity

• Implement graded increasing activity programs 4
• Focus on gradually building physical activity levels 2, 5

Psychological Support

• Address co-morbid psychiatric conditions, particularly mood disorders 4
• Consider family-focused interventions to improve family dynamics 3

Prognosis

• With appropriate intervention, recovery can be expected in over two-thirds of children with chronic fatigue 4
• Early identification of risk factors for persistent fatigue allows for more targeted interventions 2