Fatigue in children

Children present with fatigue as an isolated symptom less commonly than adolescents and adults, but parents may worry about reduced energy levels and endurance. Parents may report that their child is having trouble concentrating, is clumsy or less active than usual, or is needing longer or more frequent sleeps.

When assessing a child with fatigue, take a careful dietary history and document weight and height. Investigations can often be difficult or distressing in children—this should be considered when deciding whether and how to investigate fatigue.

Iron-deficiency anaemia is common in children and should be ruled out in children with fatigue. Growing children have increased iron requirements that may not be met by the dietary habits of the family. Other factors that can cause or contribute to iron deficiency in children include excessive cow’s milk consumption, delayed introduction of iron-containing solids, restrictive food preferences (eg in children with autism or avoidant/restrictive food intake disorder), and intestinal worms (eg in remote communities).

Recurrent viral illnesses and upper respiratory tract infections can contribute to fatigue, especially over the winter months.

Ask about sleep problems; see Sleep problems in children and adolescents and Sleep-disordered breathing in children.

Pallor or bruising warrant careful clinical assessment. Although malignancy is rare in children, it may be reasonable to request a full blood count to allay parental concerns.