Management of chronic fatigue syndrome/myalgic encephalomyelitis in a pediatric population: A scoping review
Authors: Jane Murphy
Sarah S Collard
Journal: Journal of Child Health Care (2019)
Discipline: CLINICAL MEDICINE
Keywords: Adolescent; children; chronic fatigue syndrome; myalgic encephalomyelitis; pediatric.
Affiliations: Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Bournemouth, UK.

Abstract:  Chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) negatively impacts the quality of life for children with the condition. Although up to 2% of children have CFS/ME, the bulk of research investigates adults with CFS/ME. Using the PRISMA extension for a scoping review and the work of Arksey and O'Malley (2005), a scoping review was conducted of all relevant peer-reviewed research investigating nutrition, exercise, and psychosocial factors within a pediatric population diagnosed with CFS/ME. Key themes found were nutrition and dietary components, exercise therapy, psychosocial factors, and multifaceted treatment. Nutrition was explored on its own as a tool to decrease symptoms; however, there were very few studies found to examine nutritional deficiency or treatment with those under the age of 18. Graded exercise and resistance training improved fatigue severity and symptoms of depression in adolescents with CFS/ME. Research exploring psychosocial factors of CFS/ME presented attributes that could lead to being diagnosed as well as barriers to treatment. The multifaceted treatment undertaken typically consists of graded activities/exercise, cognitive behavioral therapy, nutritional advice, and family sessions. This has shown to increase school attendance and decrease the severity of the fatigue for adolescents. Minimal literature exploring CFS/ME within a prepubescent population presents the need for further research. 

Retracted: No

PubPeer comments:
 The study is open-label and the primary outcome is subjective, hence the study is exposed to bias. However, it is the patient cohort which cause the greatest concern. In 2015, National Academy of Medicine (NAM, former IOM) published their u201cBeyond Myalgic Encephalomyelitis Chronic Fatigue Syndrome: Redefining an Illnessu201d. Among other, the NAM-report state that post-exertional malaise (PEM) is a hallmark of ME, and a mandatory symptom for the ME-diagnosis. The consequences of NAMu2019 conclusion is that case criteria including PEM as a mandatory symptom (like CCC, ICC or SEID) have to be used in recruiting study participants. https: www.nap.edu catalog 19012 beyond-myalgic-encephalomyelitischronic-fatigue-syndrome-redefining-an-illness This paper does not use diagnostic criteria were PEM is a mandatory symptom, as described by NAM. Consequently, the study does not necessarily include ME-patients, and for that reason do not have any relevance in understanding the disease, treatment, and care of ME-patients. The 29 papers included in this study rely on Fukuda CDC criteria or less stringent (except from one: SEID). The consequences of this is that the study does not include patients having PEM, and consequently do not apply to these patients. Surprisingly, the study has also among the 29 papers, included a one that report benefit in homeopathy. Summary: This study suffers from great bias due to poor study design and caused by the use of improper case criteria, the patients are a very heterogeneous group not necessarily suffering from ME. For others intending to study ME and ME-patients, citing this paper should be done with caution! ,