Pediatric Case Definition for ME/CFS

Diagnostic criteria summary:

A child (person under 12-13) or adolescent (12-13 to adult) to be diagnosed with pediatric ME/CFS will meet the following criteria:

1. "Clinically evaluated, unexplained, persistent or relapsing chronic fatigue over the past 3 months that:

a) "Is not the result of ongoing exertion [this does not include the child with pediatric ME/CFS who may become exhausted after minimal exertion];"

b) "Is not substantially alleviated by rest [in the pediatric ME/CFS patient, rest may provide some relief, but not eliminate the syndrome—furthermore even minimal exertion may quickly lead to renewed sickness.]"

c) "Results in substantial reduction in previous levels of educational, social and personal activities"

d) "Must persist or recur for at least all three months." [This requirement is "operationalized" by assessing 'how often the patient has experienced the symptom over the past 3 months on a 7 point scale: 1=hardly ever to 7=every day; to meet the above requirement a score of at least 4 would be indicated."]

2. "The concurrent occurrence of the following classic ME/CFS symptoms, which must have persisted or recurred during the past 3 months of illness (symptoms may predate the reported onset of fatigue)."

a) "Post-exertional malaise...with loss of physical or mental stamina, rapid muscle or cognitive fatigability."

b) "Unrefreshing sleep, or disturbance of sleep quantity or rhythm."

c) "The young person has at least one symptom from any of the following:

1) myofascial pain, 2) joint pain, 3) abdominal and/or 4) head pain"

d) The occurrence of "two or more neurocognitive manifestations, including impaired memory, difficulty focusing, difficulty finding the right word, frequently forgetting what wanted to say, absent-mindedness, slowness of thought, difficulty recalling information, need to focus on one thing at a time, trouble expressing thought, difficulty comprehending information, frequently lose train of thought, new trouble with math or other educational subjects."

e) "Finally, the fifth symptom category requires at least one symptom from two of the following 3 subcategories:

1) autonomic manifestations (neurally-mediated hypotension, postural orthostatic tachycardia, dizziness, shortness of breath, palpitations with or without cardiac arrhythmias, feeling unsteady on the feet—disturbed balance..."(see complete list via link)

2) "neuroendocrine manifestations (recurrent...feverishness and cold extremities, subnormal body temperature...sweating episodes, intolerance of heat and cold, marked weight change—loss of appetite or abnormal appetite, worsening of symptoms with stress."

3) "immune manifestations (recurrent flu-like symptoms, non-exudative sore or scratchy throat, repeated fevers and sweats, lymph nodes tender to palpitation—generally minimal swelling...new sensitivities to food, odors, or chemicals."

"Note: In about 25% of pediatric cases, the onset of the illness is insidious (slowly over time) rather than acute."