Helping Kids With JA Fight Fatigue

By Linda J. Brown

Juvenile arthritis (JA) can zap the energy and spark that keeps most kids on the go. But several factors, ranging from disease severity to sleep quality, can cause weariness, so pinpointing the cause (or causes) of your child’s fatigue can be difficult.

Children with active disease, or those in the middle of a flare, are more likely to experience fatigue, says Carol Wallace, MD, associate professor of pediatrics at the University of Washington and Children’s Hospital & Regional Medical Center in Seattle. That’s because chronic inflammation and its effects on the body can cause fatigue, says Dr. Wallace.

Another likely cause of fatigue is pain , 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, children without active arthritis can still suffer from chronic pain if they have damaged joints, Dr. Klein-Gitelman says. If that’s the case, pain, not inflammation, triggers fatigue.

Other health conditions, such as chronic fatigue syndrome, fibromyalgia and iron deficiency anemia can cause persistent tiredness, too. Chronic inflammation can affect how well the body processes iron, which can worsen anemia.

Last but certainly not least, having a chronic illness can take a toll on your child’s emotional health, which can cause physical symptoms like a fatigue.

Potential Impacts

Whatever its origin, fatigue can impact quality of life. Some kids may even turn to unhealthy “quick fixes” like energy drinks or sugary snacks to help them power through daytime sleepiness or school work.

“Plus, if you’re fatigued, you’re going to be irritable. You’re not going to interact with your friends or family as well,” says Dr. Klein-Gitelman. “It’s harder to participate in sports, hobbies and after-school activities and get your homework done. It can really affect every level of your day.”

What to Do

Depending on the causes of your child’s fatigue, these measures may help:

• Take control. If your child’s current treatment plan isn’t working as well as hoped, talk to your child’s doctor about exploring other medication options or non-drug therapies to help dial down pain and inflammation.  Also, ask your child’s doctor to check for other health conditions that may cause persistent fatigue.
• Improve rest. Arthritis 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 (i.e., warm showers or baths, reading or listening to relaxing music).
• Encourage movement. “Exercise gives you more energy, stamina, stronger muscles and can improve sleep,” says Dr. Wallace. Adult studies also show that increasing activity improves fatigue. Your child doesn’t have to participate in team sports to get the benefits either – walking, biking and swimming are all great options. Your child’s rheumatologist or a physical therapist can suggest other activities.
• Decrease stress. Stress at school or at home can cause fatigue and poor sleep, and children with arthritis are more likely to get depressed. A therapist or psychologist can suggest ways to relieve anxiety.
• Promote healthy eating. Studies show that obese adults with rheumatoid arthritis experience more fatigue than patients who aren’t, so following a nutritious diet may help your child maintain a healthy weight and curb weariness. Also, if your child is a picky eater or has a diet of sugary, processed foods, she may not be getting the nutrients she needs to fight fatigue. Your child’s doctor or a registered dietitian can help you figure out what your child's diet may be lacking, such as energizing B vitamins or iron to prevent anemia.

There is no one-size-fits-all way to manage fatigue. If low-energy continues to interfere with your child’s daily life, talk to your child’s doctor for other ways to manage it.