Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. e89-e95 (doi:10.1542/peds.2008-1260)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Google Scholar
Right arrow Articles by Bakker, R. J.
Right arrow Articles by Sinnema, G.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bakker, R. J.
Right arrow Articles by Sinnema, G.
Related Collections
Right arrow Office Practice
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

ARTICLE

Risk Factors for Persistent Fatigue With Significant School Absence in Children and Adolescents

Robert J. Bakker, MDa, Elise M. van de Putte, MD, PhDb, Wietse Kuis, MD, PhDb and Gerben Sinnema, PhDc

a Department of Pediatrics, Antonius Ziekenhuis, Sneek, Netherlands; Departments of
b Pediatrics
c Pediatric Psychology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, Netherlands

OBJECTIVE: To assess children and adolescents with severe fatigue who are referred to pediatricians and to examine whether factors can be identified at their first visit that predict worse outcomes at 1 year.

METHODS: Ninety-one patients, aged 8 to 18 years completed questionnaires about sleep, somatic symptoms, physical activity, and fatigue. They were reassessed 12 months later. Measurements at baseline and outcome were analyzed by using univariable logistic regression with persistent, severe fatigue (yes/no) and persistent school absence (yes/no) as dependent variables and baseline scores as independent variables.

RESULTS: After 12 months, 50.6% of the children and adolescents showed improvement; 29.1% had persistent fatigue, and 20.3% had persistent fatigue with significant school absence. Factors associated with the poorest outcome were sleep problems (odds ratio [OR]: 1.4 [95% confidence interval (CI): 1.1–1.8]), initial fatigue score (OR: 1.1 [95% CI: 1.0–1.2]), somatic complaints such as hot and cold spells (OR: 1.9 [95% CI: 1.2–3.0]), blurred vision (OR: 2.1 [95% CI: 1.1–4.0]), pain in arms and legs (OR: 2.0 [95% CI: 1.0–3.2]), back pain (OR: 1.8 [95% CI: 1.0–3.2]), constipation (OR: 1.7 [95% CI: 1.0–2.7]), and memory deficits (OR: 1.8 [95% CI: 1.0–3.2]). Resolved fatigue was associated with male gender (OR: 5.0 [95% CI: 1.6–15.5]) and a physically active lifestyle (OR: 1.3 [95% CI: 1.1–1.5]).

CONCLUSIONS: Assessment of predictive factors at the first visit enables the pediatrician to identify those patients with severe fatigue who are at risk of a poor outcome. Female gender, poor sleep quality, physically inactive lifestyle, and specific somatic complaints were important predictive factors.

Key Words: children • adolescents • persistent school absence • persistent fatigue • sleep • somatic symptoms • physically active lifestyle

Abbreviations: CFS—chronic fatigue syndrome • CSI—Children's Somatization Inventory • CIS-20—Checklist Individual Strength • OR—odds ratio • CI—confidence interval

Accepted Feb 26, 2009.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?