From the Guidelines
A medical workup for fatigue in a 7-year-old child should begin with a comprehensive history and physical examination by the pediatrician, followed by referrals to specialists such as psychologists or physical therapists for behavioral interventions and physical activity programs, as recommended by the most recent guidelines 1. The doctor will likely check for common causes including anemia, hypothyroidism, sleep disorders, and infections like mononucleosis. Initial laboratory tests typically include a complete blood count (CBC), comprehensive metabolic panel, thyroid function tests, and possibly tests for specific infections. Some key points to consider in the workup include:
- Screening for emotional factors like anxiety, depression, or school-related stress, as these can manifest as fatigue in children 1
- Evaluating sleep habits, ensuring the child gets 10-12 hours of quality sleep nightly
- Nutritional assessment, as poor diet or irregular eating patterns can contribute to fatigue
- Encouraging physical activity, such as cardiovascular endurance and resistance training, to help reduce fatigue 1
- Considering cognitive behavioral therapy and supportive interventions for mood, behavioral, academic, and adaptive functioning difficulties, as well as body image issues and fatigue 1 If initial tests are normal but fatigue persists, further evaluation might include more specialized tests or referrals to specialists such as endocrinologists, neurologists, or sleep specialists. Parents should track patterns of fatigue, noting when it occurs, what makes it better or worse, and any associated symptoms, as this information helps guide diagnosis. Most cases of childhood fatigue are due to lifestyle factors or temporary conditions and respond well to appropriate interventions, with a focus on physical activity and behavioral interventions 1.
From the Research
Medical Workup for Fatigue in Kids
To approach a child with fatigue, a general pediatrician should consider the following steps:
- Duration, severity, and age at onset of fatigue should be assessed 2
- Specific queries about everyday activities, sleep hygiene, and social domain could be useful in reaching a specific diagnosis and offering an appropriate treatment 2
- A physical examination should be performed to identify any underlying medical conditions 2
- Laboratory tests, such as a complete blood cell count (CBC), may be ordered to rule out anemia or other underlying conditions 3
Assessment Instruments for Fatigue
Several assessment instruments are available to evaluate fatigue in children, including:
- Child reports, such as the Pediatric Quality of Life Inventory (PedsQL) 4
- Parent reports, such as the Parent Proxy Report 4
- Staff reports, such as the Staff Report of Fatigue 4 However, the evidence for the measurement properties of these instruments varies, and further research is needed to determine their validity and reliability 4
Common Causes of Fatigue in Children
Fatigue in children can be caused by various factors, including:
- Lifestyle issues, such as lack of sleep or poor sleep hygiene 5
- Underlying medical conditions, such as anemia or chronic inflammatory conditions 6, 3
- Psychological factors, such as anxiety or depression 2 A thorough medical workup, including a physical examination and laboratory tests, can help identify the underlying cause of fatigue in children.