27 May Fatigue in Children
We explore the issue of fatigue in children and the importance of creating a good sleep routine.
What Is Fatigue?
Fatigue means feeling constantly tired, worn out and generally lacking the energy and motivation required to perform daily tasks. It is different from tiredness and lethargy, although they all have similar symptoms. Lethargy is generally associated with an underlying disease or illness, and tiredness is usually short-lived.
Fatigue is the chronic state of being tired, and tells our body it needs rest.
It can be a result of physical exertion, emotional stress or lack of sleep. However, it can also be an important sign of a more serious physical or psychological condition, and is of particular concern in younger children and babies. Parents should speak to a doctor if they notice it in their child, especially if it is not relieved by a good night’s sleep or healthy diet.
Reasons For Fatigue In Children
• Poor nutrition: Children should eat a balanced and varied diet. Low iron levels can cause anaemia, which can result in exhaustion. Inadequate nutrition and eating disorders such as anorexia and bulimia will also cause fatigue.
• Hypothyroidism: This is a rare condition in children, when the thyroid is underperforming and not producing enough thyroid hormone.
• Chronic diseases such as arthritis, heart problems, cancer, kidney problems and liver diseases.
• Infections or short-term illnesses such as colds or flu, gastroenteritis, chest infections or worms in the bowel. These can be treated by a GP.
• Medications such as anti-allergy medicines, which can cause drowsiness, and steroids, long-term use of which can cause weakness and fatigue.
• Psycho-social problems such as depression, grief and trauma can lead to fatigue, particularly in adolescents.
• Illicit drugs or alcohol: This is more likely to be a cause of fatigue in older children and adolescents.
• Chronic fatigue syndrome: This is a condition that starts with flu-like symptoms and lasts for six months or more. It is diagnosed after all other possible causes of fatigue are ruled out.
• Sleep disorders and poor or inconsistent sleep patterns. Anything that can interrupt normal sleep can cause fatigue during the day.
If a child does not have an underlying medical problem, it is likely a sleep disorder or poor sleep hygiene is the reason for fatigue.
Sleep disorders can be divided into three main groups:
• Breathing problems (such as sleep apnoea).
• Excessive daytime sleepiness (such as narcolepsy).
• Sleep-related behavioural problems. These problems include refusal to go to bed, difficulties in settling and falling asleep, and inappropriate sleep-onset associations such as only sleeping with a bottle in the mouth and waking several times during the night asking for the bottle.
The most important treatment is a good sleep routine, also known as sleep hygiene.
Rules For Good Sleep Hygiene
• A consistent and calm bedtime routine will help your child settle and prepare for bed. This includes relaxing activities in the child’s bedroom about 20 to 30 minutes before bedtime.
• Fixed bedtimes and wake times are important, because with consistency the body becomes familiar with falling asleep at a certain time. There should be no more than one hour’s difference in bedtime between school nights and weekends or holidays.
• Children should spend time in the sunlight every day, even during winter. In the evenings the opposite is recommended, keeping the room quiet, dark and cool, and avoiding media and screen games. If the child is afraid of the dark, it is fine to use a dim nightlight.
• It is important the sleeping environment be associated with positive experiences and emotions. Parents should try not to use banishment to the bedroom or early bed as punishment.
• Children should not go to bed hungry, but heavy meals within two hours of bedtime should be avoided. A small snack close to bedtime is acceptable, if required. Avoid bottles of milk during the night after 12 months of age.
• Avoid caffeine, such as coffee, tea, energy drinks and chocolate for at least three to four hours before bedtime.
• Television, computers, and mobile phones are not appropriate in the bedroom, as they encourage children, particularly adolescents, to remain ‘mentally active’ past bedtime.
• Napping during the day can affect night-time sleeping. Napping should be regulated by age, with younger children having longer and more frequent naps. By school age, most children should not need a nap.
• Regular exercise is also important. Children who exercise are exposed to sunlight, which helps regulate the sleep-wake cycle. Physical activity also prevents obesity, which can affect breathing during the night. However, it is important exercise not be undertaken directly before bedtime.
If you are still having problems with your child’s sleep behaviour, see your doctor or local community-health centre. Your GP or paediatrician may decide your child needs to be referred to a sleep specialist for review.
Virginia N. Oliveira is a sleep-medicine fellow at Sydney Children’s Hospital.
Words by Virginia Oliveira