Article Text

Download PDFPDF
Fatigue in childhood chronic disease
  1. Merel M Nap-van der Vlist1,
  2. Geertje W Dalmeijer2,
  3. Martha A Grootenhuis3,
  4. Cornelis K van der Ent4,
  5. Marry M van den Heuvel-Eibrink5,
  6. Nico M Wulffraat6,
  7. Joost F Swart6,
  8. Raphaële R L van Litsenburg7,
  9. Elise M van de Putte1,
  10. Sanne L Nijhof1
  1. 1 Department of Paediatrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3 Department of Psycho-oncology, Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
  4. 4 Cystic Fibrosis Center and Department of Pediatric Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
  5. 5 Department of Paediatric Oncology, Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
  6. 6 Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
  7. 7 Department of Paediatric Oncology-Hematology, Emma Children’s Hospital, Vrije Universiteit, Amsterdam UMC, Amsterdam, The Netherlands
  1. Correspondence to Merel M Nap-van der Vlist, Paediatrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht 3508AB, The Netherlands; m.m.vandervlist-3{at}


Background and objectives Recently, in adults, the incidence and severity of fatigue was found to exist rather independently from the somatic diagnosis. Since fatigue is distressing when growing up with a chronic disease, we aim to investigate: (1) the prevalence and extent of fatigue among various paediatric chronic diseases and (2) the effect of fatigue on health-related quality of life (HRQoL).

Design and setting Cross-sectional study in two children’s hospitals.

Patients Children and adolescents 2–18 years of age with cystic fibrosis, an autoimmune disease or postcancer treatment visiting the outpatient clinic.

Outcome measures Fatigue and HRQoL were assessed using the Pediatric Quality of Life Inventory (PedsQL) multidimensional fatigue scale (with lower scores indicating more fatigue) and PedsQL generic core scales, respectively. Linear regression analysis and analysis of covariance were used to compare fatigue scores across disease groups and against two control groups. The effect of fatigue on HRQoL was calculated. Data were adjusted for age, sex and reporting method.

Results 481 children and adolescents were assessed (60% participation rate, mean age 10.7±4.9, 42% men). Children and adolescents with chronic disease reported more fatigue than the general population (mean difference −6.6, 95% CI −8.9 to –4.3 (range 0–100)), with a prevalence of severe fatigue of 21.2%. Fatigue scores did not differ significantly between disease groups on any fatigue domain. Fatigue was associated with lower HRQoL on all domains.

Conclusions Fatigue in childhood chronic disease is a common symptom that presents across disease, age and sex groups. Fatigue affects HRQoL. Our findings underscore the need to systematically assess fatigue. Future studies should determine possible biological and psychosocial treatment targets.

  • fatigue
  • chronic disease
  • autoimmune disease
  • cystic fibrosis
  • paediatric oncology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors MMN-vdV collected and analysed the data and drafted the paper. SN designed the study and coordinated and supervised data collection and reviewed the manuscript. EMvdP, MAG, KvdE and GWD designed and supervised the data collection and interpretation and reviewed the manuscript. MMvdH-E, NW, JFS and RRLvL critically reviewed the data analyses and reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available on reasonable request.

  • Patient consent for publication Not required.