When your child has juvenile arthritis (JA), fatigue can sap the energy and spark that often keeps kids on the go. Although it may require a bit of detective work, you can help your child and his doctor to get to the root of what’s causing the extreme tiredness.
What Causes Fatigue?
Fatigue is a complex condition. Several factors, ranging from the way a child's body deals with a chronic disease to her inability to get good sleep, may be responsible. But certain key factors are related to arthritis.
Children with active disease, especially those experiencing flares, are more likely to feel fatigued.
“When the disease is active, chronic inflammation and its effects on the body may produce fatigue,” says Carol Wallace, MD, associate professor of pediatrics at the University of Washington and Children’s Hospital & Regional Medical Center in Seattle.
Another likely cause of fatigue is pain. “I think pain makes you very tired,” says Marisa Klein-Gitelman, MD, associate professor of pediatrics and head of the division of rheumatology at Children’s Memorial Hospital in Chicago. Although pain and inflammation often go hand in hand, Dr. Klein-Gitelman says that children without active arthritis can still suffer from chronic pain if they have damaged joints. In these cases, pain, not inflammation, triggers their fatigue.
Other health conditions may be producing fatigue. Having chronic fatigue syndrome or fibromyalgia can cause constant, extreme tiredness. Also, your child could have an iron deficiency (anemia), which can also produce fatigue. That’s because chronic inflammation affects how well the body processes iron, which can worsen anemia.
Living with a chronic disease can be a burden on a child’s emotions. Emotional health issues can also cause physical symptoms including fatigue.
Huge Potential Impacts
Whatever fatigue’s origin, it can greatly impact a child’s quality of life. Fatigue can lead to daytime sleepiness and night-time sleep problems, trouble concentrating at school and a search for unhealthy quick fixes.
Plus, “if you’re fatigued you’re going to be irritable. You’re not going to interact with your friends or family as well. It’s harder to participate in sports, hobbies and after-school activities, and get your homework done. It just becomes this huge thing that can really affect every level of your day,” concludes Dr. Klein-Gitelman.
What to Do
If fatigue interferes with your child’s day-to-day functioning, talk to your child’s doctor. Depending on the cause(s), here are some measures that may help:
Take control. Changing medications or using nondrug therapies may help better control her pain and inflammation, two of the most common fatigue triggers. Talk with your child’s doctor about options. Also, you should also check if your child has another health condition that causes ongoing tiredness.
Sleep well. JA can affect sleep quality, so encourage your child to practice good sleep hygiene. This includes sticking to a regular sleep schedule, avoiding caffeine before bedtime, and creating a relaxing bedtime routine (for example, warm showers or baths, reading, listening to relaxing music). Click here for more sleep hygiene tips.
Get moving. “Exercise gives you more energy, stamina, stronger muscles and can improve sleep,” says Dr. Wallace. Studies in adults show that increasing activity improves fatigue. A 2015 study led by Patricia Katz, Ph.D., professor of medicine and health policy at the University of California San Francisco, found that giving an adult with RA a pedometer and modest step goals improved physical activity and decreased fatigue. Your child doesn’t have to participate in team sports. Walking, biking or swimming are great options. Your child’s rheumatologist or a physical therapist can suggest other activities.
Stop stressing. Stress at school or at home can cause fatigue and poor sleep, and clinical depression is much more likely in children with JA. A therapist or psychologist can suggest ways to relieve anxiety.
Eat smart. A nutritious diet can help your child maintain a healthy weight, and studies show that obese adults with RA experience more fatigue than patients who aren’t. If your child is a picky eater or has a sugary diet of processed foods, she may not be getting the nutrition she needs. Your doctor or a registered dietitian can help you figure out what your child's diet may be lacking, like iron to prevent anemia.
There is no one-size-fits-all way to manage fatigue. Working with your child and his doctor to find the possible causes is the first step.