Fatigue Evaluation and Management in Teenagers

Initial Assessment and Severity

The American College of Physicians recommends quantifying fatigue severity using a 0-10 numeric scale over the past 7 days, and if the score is ≥4, proceed with a focused evaluation targeting treatable conditions rather than extensive laboratory testing 1, 2
The National Comprehensive Cancer Network suggests using a numeric rating scale (0-10) to assess fatigue severity, with scores of 0-3 indicating mild fatigue and scores of 4-10 indicating moderate to severe fatigue 3, 1
Scores ≥7 typically indicate a marked decrease in physical functioning and require urgent attention 3, 1

The American Academy of Pediatrics recommends assessing fatigue characteristics, including onset, pattern, duration, and changes over time, as well as associated or alleviating factors 1
The National Comprehensive Cancer Network suggests evaluating sleep quantity and quality, including sleep hygiene behaviors and screen time before bed 4
A complete medication review, including over-the-counter, herbal supplements, and vitamins, is recommended to identify potential contributors to fatigue 4, 2

The American College of Physicians recommends initial screening tests, including complete blood count with differential, comprehensive metabolic panel, thyroid-stimulating hormone, and erythrocyte sedimentation rate and C-reactive protein for inflammation 2, 6
Additional testing, such as nutritional assessment and infectious disease screening, may be necessary based on clinical context 5, 6
Imaging studies, such as chest X-ray, CT, or PET/CT, should only be pursued if red flags are present 2, 6

The American Academy of Pediatrics recommends addressing sleep disturbances through cognitive behavioral therapy for insomnia and improving sleep hygiene 5, 4
The National Comprehensive Cancer Network suggests treating depression and anxiety if identified, as well as managing pain effectively 1
Restoring nutritional deficiencies with appropriate supplementation is also recommended 5
Initiating a structured physical activity program with stretching and aerobic exercise 2-3 times weekly for 30-60 minutes is recommended for all patients regardless of cause 2

The American College of Physicians recommends rescreening at regular intervals for symptom evolution 3, 1
Watchful waiting with regularly scheduled follow-up is appropriate if diagnosis remains unclear after initial workup 3, 1