MANY years of research have made little progress in identifying the cause of chronic fatigue syndrome. Studies continue to express uncertainty and doubt that a single agent will be identified that can uniformly account for the illness in the near future.
At present there is no single treatment for chronic fatigue syndrome in children. There is no specific remedy that can be applied in these cases.
Appropriate treatments are multiple including rehabilitative, supportive with emphasis on increasing activities alongside symptom management. Most are tailored to the patient's needs.
1. Restore courage and self confidence
The child and his parents need assurance that there is hope. That the child will get better. That the illness is not life threatening. It is rarely progressive and does not have residual disabilities.
However, parents and the child should be clearly informed that improvement is a slow process. That recovery may take months or even years.
2. Early treatment to prevent muscle wasting
Treatment should be started early to prevent muscle wasting. As little as one week rest will result in significant loss of muscle volume and prolonged rest of about 4-6 weeks can result in 40% loss of muscle strength. Exercise after prolonged rest will result in exhaustion.
Early treatment should be encouraged to prevent the vicious cycle of muscle wasting: rest, rest induced exhaustion and more rest leading to more exhaustion, etc.
Early treatment will also help divert the child's feeling of frustration of having the physical and mental limitations brought about by the illness. At the same time prevent the child from reaching the point of losing the desire to move on.
3. Gradually increase activities
Activities should be paced carefully into achievable goals usually broken up into 20-40 minutes activities with periods of 15-20 minutes rest and relaxation. Activities should be increased gradually and progressively as tolerated by the child.
Participation in sports, games and physical education should be limited or reduced temporarily until the child regains his strength and stamina.
4. Temporary relief of academic pressure but maintain social interactions
The child may need to be relieved temporarily from the academic pressures in school. Home learning with or without tutorials maybe considered. Return to school should be encouraged as soon as possible to avoid social isolation, depression and school phobia.
Re-introduction to learning should be done gradually. The child should maintain social and peer group interactions during the treatment through telephone or short home visitations. Try to avoid long conversations.
5. Adequate nutritional support
Diet with adequate calories including vitamins and minerals is part of a well-balanced treatment program for children with chronic fatigue syndrome. Feedings should be given at regular intervals as tolerated or at frequent small meals if the child tires during regular meals.
6. The use of drugs
Pain management with paracetamol or ibuprofen for headaches, joint pains, muscle pains and other discomforts. Adolescents with orthostatic hypotension (difficult of standing-up because of dizziness from low blood pressure) maybe benefited with adequate amounts of fluid at least 2 liters a day. The volume of fluid maybe increased to compensate for loses after exercise or during warmer weather. Extra salt should be added to food.
If there is no improvement, drugs such as corticosteroids or atenolol may be tried in the hospital under the supervision of a physician.
Many other medications such as large doses of acyclovir and intravenous immune globulins have been tried including some popular herbal energy supplements. None have been documented to be effective at present. Some of these herbal substances may have harmful adverse effects. For efficacy and safety consult your doctor first before any attempt is made in using any of these substances. (PVI)
