Tiredness

What is tiredness?

Children get tired just as adults do and that can lead to its own set of problems, but it's usually alleviated by a couple of early nights.

Children under five typically show a 'start-stop' pattern of activity when they're intensely active for a short period and then exhausted, briefly, until their batteries recharge. This pattern can be repeated many times in a single day.

Symptoms

Most tiredness that children experience is normal everyday tiredness, often made worse by hunger. Other causes can include sleep disturbance, psychological problems and the majority of illnesses can cause tiredness or fatigue. Other symptoms will depend on the cause of the fatigue and are therefore hugely varied.

In most illnesses tiredness is not usually the only or major symptom but in glandular fever (infective mononucleosis) it may be one of the worst symptom. Glandular fever is caused by infection with the Epstein-Barr virus.

Other symptoms of glandular fever include fever, severe tonsillitis, rashes and jaundice. After recovering from the acute infection, some people find that they get very tired easily and are unable to do things that they did before they became unwell. It can last for up to 3 months.

Children may also be tired in the daytime if they suffer from obstructive sleep apnoea. This is often caused by enlarged tonsils and adenoids. It may present as snoring or mouth breathing. It can disrupt the sleep cycles of a child, leaving them tired in the daytime.

Causes and risk factors

Physical illnesses that cause tiredness in children include:

• infection, for example, throat, chest, ear, gut or tooth, glandular fever
• obstructive sleep apnoea
• chronic illness such as tuberculosis, chronic kidney disease, ulcerative colitis
• anaemia
• poor diet leading to vitamin and mineral deficiencies

Practically any illness can cause tiredness. Most common are infections. Children suffer frequent coughs, colds and respiratory infections, which often are associated with a couple of days of low energy and fatigue. This usually gets better quickly, as the fever goes down and other symptoms resolve.

Occasionally, especially after a bacterial throat infection, tiredness can persist, sometimes resurfacing intermittently for several weeks.

Tiredness may be an early sign of more serious conditions, such as diabetes or cancer (particularly blood cancers such as leukaemia), although these are rare. It's important to be alert for other symptoms such as weight loss, excessive thirst or frequent needing to urinate, all of which are signs of diabetes.

The following can help you to decide whether your child's tiredness requires further investigation:

• Keep a diary of your child's day, including symptoms or complaints of tiredness, to look for triggers.
• Check their sleeping environment - are brothers or sisters keeping them awake?
• Check sleeping hours - most children need at least ten hours a night, ideally with a consistent bedtime.
• Could sleep apnoea be a problem?
• Check your child's diet: iron is essential to build red blood cells and avoid anaemia, particularly once girls have started their periods
• You may want try a course of vitamin supplements, especially if it's a problem persuading them to eat plenty of fresh fruit and vegetables.
• If tiredness is worse before meals, their blood sugar may be dipping - try healthy snacks between meals.
• Talk to your child and encourage them to discuss their worries with you.

Tiredness rarely persists for long in children. If it goes on for more than ten days, look for other symptoms and talk to your GP.