5 - Paeds - Safeguarding - CAMHS - Chronic fatigue syndrome + Sleep disorders

Question 1

define chronic fatigue syndrome

it is more neutral than?

Answer 1

persistent high levels of subjective fatigue -> rapid exhaustion on minimal exertion

more neutral than myalgic encephalomyelitis or post-viral fatigue syndrome

Question 2

Universal Sx of chronic fatigue syndrome

Answer 2

myalgia, migratory arthralgia, headache, insomnia, poor conc, irritability

Question 3

Frequent Sx of chronic fatigue syndrome

Answer 3

stomach pain, scalp tenderness, eye pain, photophobia, tender cerv LNopathy

Question 4

Prognosis of CFS?

MGMT - what is unhelpful? physio?

Answer 4

most remit spontaneously but can take years

continuous rest unhelpful and can lead to secondary complications
graded exercise by physio to slowly increase exercise tolerance

Question 5

MGMT of CFS - what may be considered? what if depressive Sx? maintain what?

Answer 5

CB?

maintain normal life incl school attendance

anti-Ds if depressive

Question 6

4 different sleep disorders?

Answer 6

difficulty settling to sleep
waking at night
nightmares
night (sleep) terrors

Question 7

Difficulty settling to sleep - common when? mostly caused by? first step in solving?

Answer 7

common in toddlers - mostly a normal expression of sep anxiety but be other causes
take Hx + sleep diary

Question 8

Difficulty settling to sleep - causes

Answer 8

too much daytime sleep
displaced cycle
overstimulation in evening
kept awake by noise etc

Question 9

Difficulty settling to sleep - simple advice? mgmt?

Answer 9

create bedtime routine, tell child to lie quietly until they fall asleep
tuck up child, leave then come back, but leave again before sleep (lengthen)

Question 10

Waking at night - normal but some will…? approach to mgmt?

Answer 10

some cry as cant settle again without parents
use graded approach
alternate night duty to share burden between parents

Question 11

nightmares - when require attention? normal mgmt?

Answer 11

indicate a morbid preoccupation or Sx of psych disorder eg PTSD

reassurance will suffice otherwise

Question 12

Night terrors - when occur?

how dif from nightmares?

Answer 12

about 1.5h after settling
parents find child:
-sat up
-disorientated
-confused
-distressed but unresponsive
child settles after a few mins and has no recollection in morning

Question 13

night terrors - may be in combo with? MGMT for most? most important part of mgmt? what can be a possible cause?

Answer 13

sleepwalking
reassurance
make env safe for sleepwalking
possibly erratic sleep schedule -> improve routine