Although chronic fatigue syndrome has no known diagnostic markers, a standardized set of diagnostic criteria has been proposed by the International Chronic Fatigue Syndrome Study Group, the Centers for Disease Control and Prevention, and the National Institutes of Health (see the accompanying table). Plioplys reviews the reasons that this disorder should not be diagnosed in children and adolescents.

Fatigue-producing diseases are more common in children and adolescents than in adults. Among the illnesses that should be excluded in children who present with fatigue are central nervous system disorders (including degenerative illnesses and space-occupying lesions), infectious diseases, myopathies, neuropathies and mitochondrial disorders. Psychiatric disorders must also be considered. Depression, anxiety and somatization are most likely, but the possibility of school phobia and family dysfunction should also be considered.

The author emphasizes that the problems involved with diagnosing chronic fatigue syndrome in children are numerous. The most important problem may be that a diagnosis of chronic fatigue syndrome may prevent recognition of a condition that may be treatable (chronic fatigue syndrome is not treatable). Also, if chronic fatigue syndrome is diagnosed after a “standard” medical work-up, rare conditions may be overlooked if the diagnostic work-up is stopped too soon. Psychologic problems may be neglected if chronic fatigue syndrome is diagnosed in children and adolescents and, finally, a diagnosis of chronic fatigue syndrome may promote a “disabled” mindset in the patient.

The author stresses that the internationally developed guidelines for chronic fatigue syndrome should not be applied to children, and that chronic fatigue syndrome should not be diagnosed in these patients.