Approach to the child with fatigue: A focus for the general pediatrician 2022, De Nardi et al

Background: Fatigue is a common, nonspecific complaint commonly used to describe various conditions, ranging from a vague, subjective sense of weariness to muscular weakness, fatigability, exercise intolerance or excessive daytime somnolence. Despite its high frequency in the general population, literature addressing the approach to the child with fatigue from a general pediatrician perspective is poor. We herein propose a review of the available evidence on the topic, providing a practical framework to assist physicians in dealing with the issue.

Methods: Data were identified by searches of MEDLINE, UpToDate, Google Scholar and references from relevant articles. Articles published between 1990 and 2021 were considered, prioritizing systematic reviews and meta-analyses. Then, an empirically-based model of approaching the tired child was proposed according to our center experience.

Results: To correctly characterize the meaning of fatigue reporting, specific clues from history and physical examination should be emphasized. Duration, severity, and the age at onset are to be considered. Then, specific queries about everyday activities, sleep hygiene and social domain could be useful in reaching a specific diagnosis and offering an appropriate treatment.

Conclusions: We suggest a pragmatic approach to fatigue in children based on age assessment, targeted questions, physical examination clues, and some laboratory first-level tests. This could provide pediatricians with a useful tool to discriminate the broad etiology of such a complaint, disentangling between psychological and organic causes. Further studies are needed to investigate the predictive value, specificity and sensitivity of this diagnostic workflow in managing the child with fatigue.
https://www.frontiersin.org/articles/10.3389/fped.2022.1044170/full

 

Uh, no, it is not. Fatigue means its own thing. Muscle weakness is its own thing. Sleepiness is also its own thing. PEM is definitely its own thing. This is FUBAR, a "scientific" paper where basic words are essentially meaningless. We can't have a serious discussion when basic facts are in dispute.

Enough with the pragmatic stuff. Complex problems cannot be solved without understanding their cause. Generic solutions are never good, by definition. It's universally garbage when the people doing those things don't even understand the words they are using. Evidence-based medicine is a complete disaster.

 

"Symptom onset must be gradual"...huh?! We know ME onset in adults is often shockingly sudden, and I'm sure it's similar in kids. What are the authors thinking?

 

Pragmatic trials aren't even supposed to be used to infer cause or etiology. They are not capable of it, especially not with the evidence they have, all a bunch of "may be" and "could be" lacking a single bit of objective evidence. This is reckless endangerment, blatant disregard for the role medicine is supposed to play, and scientifically inept.

Shows how most of the so-called principles are just a bunch of words whenever convenient.

 

Aaaargh