Dr Phil Kieran: Is it normal for my son to feel tired all the time?
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Fatigue is a common symptom in general practice and can have many different causes.
RSV (respiratory syncytial virus)is a viral illness that causes cold-like symptoms and tends to be more common in children than adults. It is at its peak in January-February and is one of the leading causes of bronchiolitis in young children, which can lead to hospitalisation. Thankfully, it is a mild, self-limiting condition for most and will settle down fully in two to three weeks.
It can, however, leave people with symptoms that drag on after the illness has passed.
In your case, with a diagnosis of RSV in a 10-year-old, I would first want to clarify the impact the fatigue is having on his life. If it is the case that he is feeling tired a lot of the time but is not changing his behaviour, then I would be happy to continue to observe without any further investigation, as his condition will almost certainly settle fully in the next three to four weeks. This would mean he is reporting fatigue, but it isn’t causing difficulties at school, he can still participate in all his sports/games/running around with his friends in general, and he isn’t falling asleep on the couch after school. If this isn’t the case, I would suggest booking him into his GP for a check-up.
The first thing I would do in the clinic is listen to his lungs. RSV can cause either a worsening or unmasking of underlying asthma or a condition called post-viral bronchial reactivity (similar to asthma but not long-term). If there is a suspicion that this is unmasked or worsened asthma, he may get a lot of relief from inhalers. Also, if this is the case, there is a good chance his sleep is of poor quality due to breathing worsening at night, leading to daytime fatigue.
I would also look to see if his fatigue could be caused by another viral infection, such as glandular fever, and not just a carry-over from the RSV infection. Depending on the individual case, I would consider sending blood tests to ensure iron levels are OK and there isn’t evidence of ongoing infection. However, I try to avoid taking blood from children as it usually doesn’t provide additional information beyond what a physical examination can reveal, and it can be very traumatic.
In a small subgroup, fatigue will persist and can get worse. This would fall into the heading of chronic fatigue syndromes, which are poorly understood. Chronic fatigue can cause post-exertional malaise, whereby any significant physical or mental exertion can leave the person feeling very unwell. However, this is very unlikely to be the case in a young child.
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