Back to School and Chronic Fatigue Syndrome

Chronic Viral Diseases Branch, Division of High-Consequence Pathogens and Pathology


December 03, 2012

Editorial Collaboration

Medscape &

With the new school year under way, it is important for school nurses, other clinicians who treat children, and educators to be aware of a poorly recognized debilitating illness that can affect adolescents and children and have an impact on their academic and social functioning. This illness is chronic fatigue syndrome (CFS), a complex illness that severely affects functioning and quality of life. CFS is often thought of as a problem in adults, but it also affects adolescents and, less frequently, children. CFS remains poorly understood by healthcare professionals, and the symptoms in children and adolescents may be misinterpreted as depression or school avoidance.

In adolescents, CFS is more likely to develop after an acute, flu-like illness or injury, but gradual onset of illness may occur. Symptoms of CFS in adolescents are similar to those in adults: debilitating mental and physical fatigue resulting in a significant reduction in activity, sleep problems (such as unrefreshing sleep and a need to sleep more during the day), marked worsening of symptoms after physical or mental exertion, muscle and/or joint pain without redness or swelling, headaches, and impaired memory or concentration. Postural orthostatic tachycardia syndrome (POTS) or orthostatic instability is frequently experienced by children and adolescents with CFS. Sore throat and tender cervical or axillary lymph nodes are also common symptoms in pediatric CFS.

Diagnosing CFS requires ruling out other treatable conditions that could be causing the symptoms. In adolescents, diagnosis is also compounded by the process of puberty, a time of hormonal fluctuation and social transition from childhood to adulthood that can contribute to problems with sleep and social adjustment. Children may have difficulty describing their symptoms.

It is most important to diagnose CFS in adolescents and children to prevent or mitigate the effects of missed school and missed opportunities for socialization. When school nurses recognize and understand the impact of CFS, they can serve as effective advocates to mobilize resources to support the child or adolescent to maximize the student's academic and social development. School absence as a result of illness is best addressed with the school, parents, and physicians as partners. Adolescence is a critical time in human development that influences the individual's adult life, and friends and socialization are particularly important during this life period. Fortunately, recovery from CFS is more common in adolescents than in adults; however, this does not occur in everyone, and long-term follow-up and adjustments are often needed.

Web Resources

Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) Association of America: Research 1st. Pediatric CFS: Gains and Gaps.

Chronic Fatigue and Immune Dysfunction Syndrome Association of America: CFS Fact Sheet - Pediatric CFS

CFIDS Chronicle. Pediatric CFS.

Centers for Disease Control and Prevention. Chronic Fatigue Syndrome.