Fatigue is a common and troubling symptom in children with serious illness. Coping with fatigue impacts and diminishes quality of life in multiple ways. Despite the well-established impact of fatigue, clinicians tend to underrecognize and undertreat this symptom. This chapter examines fatigue as it presents in pediatric patients and suggests best practices for evaluation and treatment. Common causes of fatigue include anemia, medications, pain, disordered sleep, nutritional imbalance, changes in physical activity, emotional and/or spiritual distress, and medical comorbidities. Each case should be evaluated separately, with a focus on treating the underlying cause of the fatigue when possible. An interdisciplinary approach is often required to fully address the factors contributing to a patient’s fatigue. Nonpharmacologic approaches have been shown to be effective and may be used in concert with pharmacologic agents.
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