Objective: To define outcomes of pediatric patients with chronic fatigue.
Design: Cohort study with a mean follow-up of 3.8 years.
Setting: Outpatient pediatrics department at a university health center.
Patients: Patients 21 years old and younger referred by their private physicians for evaluation of unexplained fatigue lasting at least 3 months.
Intervention: Patients were seen from January 1986 through April 1990 and were telephoned in April 1992 to determine outcome.
Results: Of the 55 patients who were evaluated from 1986 to 1990, an organic cause of the fatigue, sinusitis, was found for one. Of the 54 patients with unexplained fatigue, 48 were contacted in 1992. The mean age of these 48 patients was 15 years; 73% were female. Fatigue was present a mean of 7 months before evaluation, and in 78% an acute illness preceded the fatigue. Most patients believed their fatigue had an organic cause. In general, laboratory studies were not helpful. All patients were encouraged to resume normal functioning despite their symptoms. At follow-up, 65% reported resolution of symptoms, 29% reported improvement, and 6% were unchanged.
Conclusions: In pediatric patients with chronic fatigue, diagnostic and therapeutic interventions should be based on positive findings; with simple encouragement, the prognosis is excellent. Based on this experience, we suggest a structured approach to the management of pediatric patients with chronic fatigue.