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Is chronic fatigue syndrome (CFS/ME) heritable in children, and if so, why does it matter?
  1. Esther Crawley1,
  2. George Davey Smith2
  1. 1
    Centre for Child and Adolescent Health, Hampton House, Cotham Hill, Bristol, UK
  2. 2
    MRC Centre for Causal Analyses in Translational Epidemiology (CaiTE), Department of Social Medicine, University of Bristol, Bristol, UK
  1. Esther Crawley, Centre for Child and Adolescent Health, Hampton House, Cotham Hill, Bristol BS6 6JS, UK; Esther.crawley{at}bristol.ac.uk

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We need a clear definition of CFS/ME in children and sample sizes for genetic studies need to be much larger

Chronic fatigue syndrome or ME (CFS/ME) is surprisingly common in children with a prevalence of between 0.19% and 2% based on telephone surveys in the UK and the USA.13 Lifetime prevalence (up to 30 years old) of self-reported CFS/ME, uncorroborated by a physician, of 0.8% has been reported from the 1970 British Birth Cohort.4 Lifetime prevalences (age 8–17) of disabling fatigue of 3 months’ and 6 months’ duration of 2.34% and 1.29% have been reported from a longitudinal cohort of twins.5 This means that almost all paediatricians reading this article will have seen and managed children with CFS/ME. Some paediatricians will have noted a family history of CFS/ME and may have wondered whether this was due to genetic heritability or an environmental factor. The causes of CFS/ME have long been debated, which has not necessarily been helpful to the clinical management of children with CFS/ME.68 This article examines the evidence base for the genetic heritability of CFS/ME. This is an important area of knowledge for paediatricians as it will inform our discussions with children, young people and their families.

FAMILIAL AGGREGATION

The familial aggregation of CFS/ME was first described 16 years ago in Lyndonville, New York State. In this study, a questionnaire asking about symptoms of CFS/ME and possible risk factors (allergies, asthma, risk factors for infection and family history) was distributed to all 914 students at the Lyndonville Central School. Having a family member with CFS/ME was a strong predictor of CFS/ME, with a risk ratio of 35.99 (it is not clear from the study whether the authors only asked about first degree relatives or “any” relatives). The authors concluded that this …

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