Fibromyalgia in Pediatric Patients – How Common Is It?
Diagnosing common childhood illnesses like strep throat or ear infections is typically straightforward. However, when kids experience vague symptoms such as fatigue, achiness, and sleep disturbances, pinpointing the cause becomes more challenging. One condition that might sometimes be overlooked in children and adolescents is fibromyalgia, characterized by pain in the muscles and soft tissues around the joints. (1)
Fibromyalgia in pediatric patients is relatively less common compared to its occurrence in adults. This condition primarily affects adults, with the majority of cases occurring in individuals over the age of 18. However, it is important to acknowledge that fibromyalgia can also affect children and adolescents.
In children, fibromyalgia falls under the category of juvenile primary fibromyalgia syndrome (JPFS). If a child also has arthritis or another condition linked to fibromyalgia, it is referred to as juvenile secondary fibromyalgia syndrome. (2)
Estimates suggest that approximately one to seven percent of children may experience fibromyalgia or conditions similar to it, falling under the category of musculoskeletal pain syndromes. (3) While less prevalent in this age group, it is essential to recognize that fibromyalgia can indeed manifest in pediatric patients.
In fact, it is interesting to note that according to a 2019 study, Juvenile Fibromyalgia Syndrome (JFMS) is estimated to affect approximately one to six percent of children in the United States alone, with a higher prevalence among teenage girls. The prevalence rates of JFMS in the United States are as follows: (4)
- 0.5-1 percent in children aged 0 to 4 years
- 1-1.4 percent in children aged 5 to 9 years
- 2-2.6 percent in children aged 10 to 14 years
- 3.5-6.2 percent in teenagers aged 15 to 19 years
This highlights the importance of considering fibromyalgia as a potential diagnosis, particularly when children exhibit symptoms like widespread pain, fatigue, and sleep disturbances, which might be indicative of this condition. Seeking professional medical evaluation and guidance is crucial for accurate diagnosis and appropriate management in pediatric cases of fibromyalgia.
Recognizing Symptoms of Fibromyalgia in Pediatric Patients
Fibromyalgia symptoms in children can manifest differently from those in adults. Common signs of fibromyalgia in pediatric patients may include:
- Pain Throughout The Body: This pain is often described as a deep, persistent ache that is felt in multiple areas of the body, including the neck, shoulders, back, and limbs. Children may have difficulty pinpointing the exact location of the pain, and it can be symmetrical, meaning it occurs on both sides of the body. (5)
- Fatigue: Fibromyalgia-related fatigue goes beyond typical tiredness. It’s a pervasive sense of physical and mental exhaustion that can impact a child’s daily activities and overall quality of life. (6) It is important to understand that fatigue in children with fibromyalgia extends beyond typical tiredness – it is a pervasive sense of physical and mental exhaustion. This profound fatigue can significantly impact a child’s ability to engage in daily activities, attend school regularly, and participate in recreational pursuits. It often persists even after a full night’s sleep, leading to a constant need for rest and potential disruptions in academic and social functioning
- Morning Stiffness: Morning stiffness, similar to what is seen in conditions like arthritis, is a common symptom. This stiffness can be particularly noticeable after periods of inactivity. Children may experience significant discomfort and restricted movement upon waking or after periods of inactivity. This stiffness can be particularly pronounced, potentially affecting their ability to engage in daily routines and activities, emphasizing the disabling nature of this condition. (7)
- Sensitivity to Touch: Known as allodynia, this is an increased sensitivity to pressure or touch. Even gentle contact or clothing against the skin can cause discomfort or pain.
- Sleeping Issues: Children with fibromyalgia often struggle with sleep. They may have difficulty falling asleep, staying asleep, or achieving restorative sleep. This can lead to chronic sleep deprivation.
- Cognitive Difficulties or Brain Fog: “Fibro fog” can manifest as problems with memory, concentration, and cognitive processing. This cognitive impairment can affect academic performance, making it challenging to retain information, focus on tasks, and participate actively in school activities. It can lead to frustration and decreased self-confidence, impacting a child’s overall quality of life and well-being. (8)
- Headaches: Recurrent headaches or migraines are common in children with fibromyalgia. These headaches can be severe and may contribute to the overall pain burden.
- Digestive Issues: Some children with fibromyalgia may experience gastrointestinal symptoms like abdominal pain, bloating, constipation, or diarrhea. These symptoms can further contribute to discomfort and distress. These gastrointestinal discomforts can exacerbate the overall discomfort and distress experienced by the child. It is important to address these symptoms promptly to ensure the child’s overall well-being and quality of life. Additionally, a holistic approach to treatment may involve dietary adjustments and other interventions to alleviate digestive discomfort. (9)
- Restless Legs Syndrome: This neurological condition is characterized by an uncomfortable sensation in the legs, often described as a crawling or tingling feeling. Children may have an urge to move their legs, especially at night.
- Joint Pain: While joint swelling is not typically associated with fibromyalgia, some children may experience pain or discomfort in the joints.
- Other Symptoms: Less commonly, children with fibromyalgia may experience symptoms like dizziness, lightheadedness, irritable bowel
A 2017 study examined 34 adolescents with Juvenile Fibromyalgia Syndrome (JFMS) and compared them to 31 adolescents without the condition. The study discovered that those with JFMS demonstrated heightened sensitivity to pressure-induced pain. (4) Moreover, the research indicated that this heightened pain sensitivity was not solely linked to anxiety levels. This suggests that the experience of pain in JFMS may be attributable not only to anxiety, but also to alterations in the central nervous system’s mechanisms for processing pain.
Why is it Important to Recognize the Signs of Fibromyalgia in Pediatric Patients?
Recognizing the signs of fibromyalgia in pediatric patients is crucial for several reasons:
- Early Intervention and Treatment: Identifying fibromyalgia early allows for prompt intervention and treatment. This can help alleviate symptoms, improve the child’s quality of life, and prevent potential complications or the exacerbation of symptoms over time.
- Improved Quality of Life: Fibromyalgia can significantly impact a child’s daily functioning, including their ability to attend school, participate in activities, and maintain social connections. Recognizing the signs enables healthcare providers to implement strategies to enhance the child’s overall well-being.
- Tailored Management Plans: Early diagnosis allows for the development of personalized treatment plans. This may involve a combination of medications, physical therapy, cognitive behavioral strategies, and lifestyle modifications tailored to the child’s specific needs.
- Addressing Psychological Well-being: Fibromyalgia can contribute to emotional and psychological challenges in children. Recognizing the condition provides an opportunity to address any associated anxiety or depression, ensuring comprehensive support for the child’s mental health.
- Preventing Misdiagnosis: Fibromyalgia can mimic other conditions, and a timely diagnosis helps prevent misidentification and the pursuit of unnecessary treatments or interventions.
- Educational Support: Recognizing fibromyalgia in a child allows for the implementation of necessary accommodations and support within educational settings. This may include adjustments in attendance policies, modifications to physical activities, and additional resources to help the child succeed academically.
- Fostering Trust and Communication: Acknowledging a child’s experience and validating their symptoms fosters trust between the child, their caregivers, and healthcare providers. It encourages open communication, ensuring that concerns are addressed and treatment plans are followed effectively.
- Preventing Long-term Impact: Untreated or undermanaged fibromyalgia can lead to chronic pain and disability, which may persist into adulthood. Early recognition and intervention can help mitigate the long-term impact on the child’s physical and emotional well-being.
Recognizing the signs of fibromyalgia in pediatric patients is essential for providing timely and comprehensive care, ultimately improving their quality of life and long-term outcomes.
Diagnosis and Treatment of Fibromyalgia in Children
Here’s a brief overview of how fibromyalgia is diagnosed and treated in pediatric patients.
- Thorough clinical assessment, including medical history and physical examination.
- Exclusion of other potential causes of symptoms.
- Consideration of symptom duration and tender points examination.
- Multidisciplinary approach involving medical, psychological, and lifestyle interventions.
- Medications for pain relief and mood management.
- Physical therapy, low-impact exercise, and sleep management.
- Cognitive Behavioral Therapy (CBT) for symptom management.
- Stress management techniques and nutritional support.
- Education, school accommodations, and regular follow-ups for optimal care.
Recognizing fibromyalgia symptoms in pediatric patients is essential for early intervention and tailored treatment. This proactive approach improves their quality of life, supports academic success, and addresses emotional well-being. By identifying and addressing fibromyalgia early, healthcare providers can provide comprehensive care, ensuring better long-term outcomes for these young individuals.
- Romano, T.J., 1991. Fibromyalgia in children; diagnosis and treatment. The West Virginia Medical Journal, 87(3), pp.112-114.
- Anthony, K.K. and Schanberg, L.E., 2001. Juvenile primary fibromyalgia syndrome. Current rheumatology reports, 3(2), pp.165-171.
- Buskila, D., 2009. Pediatric fibromyalgia. Rheumatic Disease Clinics, 35(2), pp.253-261.
- Vincenzo, A., Ashraf, T.S., Nada, S., Bernadette, F. and Christos, K., 2019. The juvenile fibromyalgia syndrome (JFMS): a poorly defined disorder. Acta Bio Medica: Atenei Parmensis, 90(1), p.134.
- Sluka, K.A. and Clauw, D.J., 2016. Neurobiology of fibromyalgia and chronic widespread pain. Neuroscience, 338, pp.114-129.
- Bennett, R., 1998. Fibromyalgia, chronic fatigue syndrome, and myofascial pain. Current opinion in rheumatology, 10(2), pp.95-103.
- Bennett, R.M., 2009. Clinical manifestations and diagnosis of fibromyalgia. Rheumatic Disease Clinics, 35(2), pp.215-232.
- Kravitz, H.M. and Katz, R.S., 2015. Fibrofog and fibromyalgia: a narrative review and implications for clinical practice. Rheumatology international, 35, pp.1115-1125.
- Triadafilopoulos, G., Simms, R.W. and Goldenberg, D.L., 1991. Bowel dysfunction in fibromyalgia syndrome. Digestive diseases and sciences, 36, pp.59-64.
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