From the Guidelines
To treat fatigue in pediatric patients after illness, encourage physical activity, such as cardiovascular endurance and resistance training, as it is a strong recommendation based on moderate level of evidence 1. When establishing an exercise program, start with a discussion and low-level activities that can be gradually increased, especially in individuals who are very deconditioned 1. Consider encouraging physical activity in infants and young children through play, and children receiving intensive chemotherapy and undergoing hematopoietic cell transplant (HCT) as young as 8 years old can participate in yoga 1. Aerobic, neuromotor, or combination exercises may be more effective for reducing fatigue 1. Additionally, counseling regarding coping with fatigue and education about anxiety and depression, which are commonly associated with fatigue during cancer treatment, may be beneficial 1. Relaxation and/or mindfulness among children/adolescents who can participate may also be effective in reducing fatigue 1. It is essential to monitor for signs that fatigue isn't improving after 2-3 weeks, as persistent fatigue may indicate an underlying condition requiring medical attention. Some key points to consider when treating fatigue in pediatric patients after illness include:
- Encouraging regular sleep schedules with age-appropriate sleep duration
- Providing a balanced diet rich in fruits, vegetables, whole grains, and lean proteins, with proper hydration
- Ensuring the child takes any prescribed medications for the underlying illness
- Considering a multivitamin if dietary intake is poor, but consulting with a healthcare provider first. If fatigue persists beyond 2-3 weeks, is accompanied by fever, significant weight loss, or other concerning symptoms, seek medical evaluation promptly.
From the Research
Treatment of Fatigue in Pediatric Patients
To treat fatigue in pediatric patients after illness, several factors need to be considered, including the underlying cause of the fatigue, the patient's age, and their overall health status.
- Fatigue can be a prevalent symptom in patients with life-threatening illnesses, and addressing it is crucial for effective palliative care 2.
- In pediatric oncology patients, fatigue is a disruptive symptom that requires clinical intervention, and its definition, measurement, and intervention should consider the treatment context and the child's development 3.
- Studies have shown that children and adolescents with cancer define fatigue differently, with children emphasizing physical sensation and adolescents emphasizing physical and mental tiredness 3.
- Parents and staff view themselves as responsible for alleviating patient fatigue, while patients view rest and distraction as primary sources of improving fatigue 3.
Identifying and Managing Fatigue
- The Pediatric Quality of Life Inventory Multidimensional Fatigue Scale can be used to assess fatigue in children after critical illness 4.
- Baseline indices of severity of illness may not be associated with fatigue, highlighting the need to consider the heterogeneity of patients and the multidimensional nature of fatigue symptoms 4.
- Deficiency testing for iron, vitamin B12, and folate can help identify underlying causes of fatigue, such as anemia, which can be characterized by low hemoglobin concentration and symptoms like weakness and lethargy 5.
Current Perspectives on Pediatric Chronic Fatigue Syndrome
- Pediatric chronic fatigue syndrome is a relatively common and disabling illness that can have a wide range of impacts on the child, family, and healthcare systems 6.
- The majority of children with chronic fatigue syndrome can get better with specialist treatment, highlighting the importance of early diagnosis and intervention 6.