Management of chronic fatigue syndrome/myalgic encephalomyelitis in a pediatric population: A scoping review.
Sarah S Collard, Jane Murphy
PMID 31379194WHAT IT FOUND
Pediatric CFS/ME management evidence centers on graded activity, CBT, and family-inclusive multidisciplinary programmes; milk intolerance may matter in some adolescents.
Evidence is patchy, especially under 12, so use individualized plans, not single fixed treatments.
Key findings
01Cognitive behavioural therapy was reported as the most successful psychological therapy for adolescents, with positive reports across quality of life, school attendance, mood and CFS/ME symptoms.
02Graded exercise and multifaceted programmes were reported to improve fatigue, mood, school attendance or illness severity, but many interventions combined components, so the effect of any single component cannot be separated.
03Milk intolerance was reported in 31% of adolescents and young adults with CFS/ME, and a six-month milk-free diet was associated with health-related quality of life no longer significantly different from milk-tolerant CFS/ME participants.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for RNs
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What it does not show
The review included 29 studies, and many were small, pilot or heterogeneous. It does not establish a single effective treatment. Only two studies examined multifaceted treatment in children under 10, and few studies focused on children under 12. Some included studies examined adolescents and adults together. Findings may not apply to younger children. Outcome measures varied, and some were not validated. Comparison across studies was difficult. Interventions often combined CBT, exercise, nutrition and family sessions. The contribution of any one component cannot be separated. Only one study examined exercise therapy in isolation, so most exercise findings came from combined programmes. The review found little evidence on pharmaceutical or immunological treatments. The review grouped studies by theme rather than pooling results. It maps evidence. It does not estimate effect size.
Declared interests
The authors declared no potential conflicts of interest. The work was supported by the Silk Trust.
The easy way to misread this
Do not conclude that graded exercise, CBT or a milk-free diet alone is proven to work for every child with CFS/ME. Many studies combined treatments, sample sizes were small, and evidence was limited for children under 12.