Article Index

Pediatric session

Although CFS/ME is known to occur in children and adolescents, pediatricians have been hampered by the absence of a case definition for children. The adult research definition (Fukuda, et al. Annals of IM, 1994) traditionally has been used, but children have age-specific issues and generally report different symptoms than adults. With this problem in mind, the IACFS developed the Pediatric Case Definition Working Group (Drs. Jason, Bell, DeMeirleir, Gurwitt, Jordan, Lapp, Miike, Torres-Harding and Van Hoof) to study the problem. For more than a year the committee studied various approaches to diagnosis, and developed a new definition, questionnaires, and a scoring sheet for pediatricians. This new definition combines the best aspects of the Fukuda definition with the best aspects of the Canadian Clinical Definition of ME/CFS (Carruthers, et al, JCFS (2003) 11(1):7-115), and has produced two questionnaires with queries that are age appropriate (for under 11 years old, and 11-18 years old).

To establish a diagnosis of pediatric CFS/ME the following five symptom categories must be satisfied:

  • Post-exertional malaise
  • Unrefreshing sleep, or a disturbance of sleep quantity or rhythm
  • Myofascial, joint, abdominal, or headache pain
  • Two or more neurocognitive manifestations; and
  • At least one symptom from two of the following three categories:

1.autonomic manifestations

2.neuroendocrine manifestations, or

3.immune manifestations

It is hoped that this pediatric case definition will lead to more appropriate identification of children and adolescents with CFS/ME. An article on the development and use of the definition will appear in the Journal of Chronic Fatigue Syndrome shortly. 

Elke Van Hoof (Vrije Universiteit Brussel, Belgium) reported on how adolescents with CFS/ME perceive their social environment. She studied 27 Belgian adolescents (mean age 16 +/- 3 years), three-quarters of whom were female. Onset of illness was sudden in 48% of cases, and it took about 1½ years to receive a diagnosis. Only 22% were able to attend school full time, and more than half (52%) reported conflicts in school. One third (33%) got help from a teacher or classmate in order to keep up, 82% had to skip classes frequently, and 70% got failing grades. Forty percent were involved in extracurricular activities once in a while, but 48% experienced no activities outside of school. Van Hoof concluded that CFS/ME in adolescence can lead to social isolation, grades that fall below true capability, and poor attendance at school. Thus the adolescent with CFS/ME is vulnerable to a poor self image and low self efficacy.