Managing chronic joint pain and fatigue in children: A guide for parents

Managing chronic joint pain and fatigue in children can be disruptive for families, affecting daily life, school routines, and emotional wellbeing.

Understanding the causes, diagnosis, and treatment options available can help you make informed decisions that support your child’s health and quality of life.

What can cause chronic joint pain and fatigue in children?

Chronic joint pain and fatigue in children can arise from several underlying health conditions. The most common causes include:

• autoimmune conditions, such as juvenile idiopathic arthritis and systemic lupus erythematosus (lupus)
• hypermobility spectrum disorder
• fibromyalgia
• chronic fatigue syndrome

Other possible causes include certain infections, such as Lyme disease, which can lead to chronic symptoms if left untreated. Metabolic and endocrine disorders, like hypothyroidism, can also contribute to fatigue and worsen joint pain.

What steps are involved in diagnosing chronic joint pain and fatigue in children?

Diagnosis in these cases can be complex and may involve multiple tests and consultations.

Your paediatric rheumatologist will start by conducting a thorough medical history review and a physical examination. They will assess the location and duration of your child’s joint pain, as well as any swelling or stiffness, fever, or rashes. They will also assess how these symptoms are affecting your child’s life and if there is a family history of autoimmune or joint conditions.

Since chronic joint pain and fatigue can have overlapping causes, your paediatric rheumatologist will then recommend a series of tests and investigations to narrow down possible causes:

• Blood tests: Blood tests may measure markers of inflammation (like ESR or CRP) and assess for autoimmune indicators, such as rheumatoid factor or antinuclear antibodies (ANA).
• Imaging studies: X-rays, ultrasound, and MRI scans may be recommended to examine the joints and surrounding tissues and identify any structural abnormalities or inflammation.

If fibromyalgia is suspected, your paediatric rheumatologist will conduct another physical examination to check for tender points and evaluate the impact of pain on movement. In cases where chronic fatigue syndrome is suspected, your paediatric rheumatologist will assess how fatigue impacts daily activities and check for related symptoms, looking for symptom patterns.

How is chronic joint and fatigue in children managed?

Managing chronic joint pain and fatigue in children requires a personalised approach that addresses the specific condition and focuses on symptom control, activity management, and quality of life.

For inflammatory conditions, non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation. In cases of juvenile idiopathic arthritis or lupus, disease-modifying antirheumatic drugs (DMARDs) or corticosteroids may be used to control the autoimmune response and prevent joint damage. For fibromyalgia, treatment may focus instead on lifestyle changes and physical therapies.

Physiotherapy is integral for managing chronic joint pain and fatigue. A paediatric physiotherapist can guide your child through gentle stretching, strengthening exercises, and low-impact activities like swimming that help maintain flexibility, strength, and stability without straining the joints. The regular movement will also help improve your child’s mood, sleep quality, and reduce pain over time.

Flare-ups or particularly painful episodes will require extra care. Medication dosages may need temporary adjustments under your paediatric rheumatologist’s guidance and you will need to ensure your child gets additional rest and reduces their physical activity during these times. Applying warm compresses to the affected areas can also ease stiffness, while cold packs may help reduce swelling in inflamed joints.

How can I support my child emotionally in managing their chronic joint pain and fatigue?

The emotional impact of chronic joint pain and fatigue shouldn’t be underestimated. Chronic symptoms can lead to feelings of frustration, isolation, sadness, and anxiety, especially if the symptoms interfere school or social activities. As a parent, you can support your child by:

Encouraging open communication

Create a safe environment where your child feels comfortable expressing their emotions freely – whether they feel frustrated, sad, or even angry. Remind your child that it’s okay to talk about the challenges they face, making them feel heard and understood.

Reaching out to a mental health professional

Many children with chronic conditions benefit from psychotherapy, such as cognitive-behavioural therapy, or counselling. A paediatric psychologist can teach your child strategies to manage pain-related anxiety and to build confidence in oneself. Practices like mindfulness, deep breathing exercises, and guided relaxation exercises can also help your child manage stress, reduce anxiety, and improve focus.

Maintaining a sense of normalcy

Inform teachers and school staff about your child’s condition to arrange necessary accommodations, such as additional time for assignments or reduced physical activities during gym class. Work together with the school to help your child feel more comfortable in their learning environment.

Additionally, encourage your child to participate in hobbies, social activities, or school events that bring them joy as much as their condition allows. If needed, speak with teachers to arrange necessary accommodations, such as rest breaks.

Lastly, connecting with support networks - whether through local community groups or hospital support programmes - can help both you and your child feel less isolated. Meeting other families who share similar experiences can be invaluable, providing encouragement and practical advice.

Chronic joint pain and fatigue are complex issues that can be challenging for parents to understand, especially as they overlap with various autoimmune conditions.

Dr Zaman’s patient-first approach, showcasing his dedication to making children’s health manageable and achievable, will offer insights into recognising symptoms, understanding possible causes, and knowing when to seek a specialist like a tertiary (specialist rheumatology) service.