Chronic Fatigue Syndrome


These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.


Chronic Fatigue Syndrome (CFS) also known as myalgic encephalomyelitis (ME) or is an illness that affects the nervous system. It can occur at any age and can affect children as well as adults.1

For some children the condition can be triggered suddenly by a virus, toxic exposure, immunisation or trauma. But often there is no known precipitant or cause. 2

Main signs

  • Extreme tiredness that lasts three months or more
  • Tiredness can’t be explained by another illness  
  • Can be worse after exercise or poor exercise tolerance
  • Difficulty sleeping 
  • Dizziness
  • Nausea
  • Racing heart
  • Pain in many possible locations
  • Sore throat
  • Difficulty concentrating or remembering things
  • General feeling of being unwell
  • Anxious or depressed mood.

Pre-referral management

Chronic fatigue syndrome is a diagnosis of exclusion. Symptoms must be present for more than three months and not explained by another medical illness.

There’s no test to diagnose chronic fatigue syndrome however a review of the child’s symptoms are useful to identify other causes. 

CFS may occur with other medical conditions such as migraine or psychiatric diagnoses (mood, anxiety).

Investigations to consider

  • Bloods: FBP, inflammatory markers, iron studies, TFT,UEC, LFT, Ca/Mg/Phos EBV serology. CK if muscle pain or weakness
  • Urine analysis
  • Check growth (plot on growth charts)
  • Check school attendance.

Treatment for Chronic Fatigue Syndrome

If the child or adolescent is diagnosed with CFS there are treatments that can help with improved symptoms and overall functioning.

An individual management plan can be developed to focus on helping the child to manage symptoms. Strategies can include:
  • Cognitive behaviour therapy
  • Activity management: looking at their current activities either decreasing or slowly increasing. 
  • Healthy diet: encouraging the child to eat a wide range of food.
  • Stress Management and relaxation
  • Medication: may be prescribed for pain management.
Some children may recover in several months but other children may take several years.3


Referrals to PCH for Chronic Fatigue Syndrome are via the Central Referral Service. More details can be found here.


  1. National Institute for Health and Care Excellence (Chronic fatigue) Emerge Australia (About ME-CFS)
  2. Medical Journal of Australia (Chronic Fatigue Syndrome Clinical Practice Guidelines, 2002),
  3. National Institute for Health and Care Excellence (Assessment and diagnosis of chronic fatigue syndrome myalgic encephalomyelitis)

Reviewer/Team: Dr Paula Holmes, Clare Franklin GENP CNS Last reviewed: May 2019

Review date: May 2021
Endorsed by:

Medical Advisory Committee (MAC) Date:  May 2019

This document can be made available in alternative formats on request for a person with a disability.

Last reviewed: 09-01-2020
Last updated: 02-06-2022