Part 2 – Risk Factors for Fibromyalgia In Children

In part 1 of this 2-part series, I went over Dr. Pellegrino’s article on Fibromyalgia in children.  The first post covered risk factors, causes of FM in children and common initial symptoms.  If you didn’t have a chance to read part 1, please read Part 1 – Risk Factors for Fibromyalgia in Children before continuing with this post. 

Aggravating Factors

Dr. Pellegrino says that certain aggravating factors may cause Fibromyalgia to flare in children.   He goes on to say:

I find that many children will experience increased pain or more widespread pain during growth spurts. Perhaps fibromyalgia is thrown “out of balance,” so to speak, as growth is occurring more rapidly than the fibromyalgia can adjust, hence the increased pain. The stress of growth may aggravate FM symptoms, or perhaps the nerves grow at a slower pace than the rest of the body and they signal more nerve pain.

Girls may notice increased pain when their menstrual cycles start, and they have exaggerated premenstrual symptoms from the very beginning.

Children are not free from stresses, at school or home, particularly if there is marital discord between the parents. All of these factors can contribute to flare-ups of FM in children.

Tender Points

Dr. Pellegrino says that many of his child FM patients have numerous tender points that are painful and “ropey muscles with localized spasms”.  The diagnosis of FM is made if the criteria is met as set by the American College of Rheumatology.

Minimal Invasiveness

Dr. Pellegrino approaches children under the age of 16 that he suspects may have FM differently than what he approaches his adult patients.  He wants to make sure with children that there are no underlying problems besides FM that could be causing their symptoms.

Usually I will obtain some lab work including blood counts, sedimentation rate, and possible thyroid studies. If cognitive difficulties are a problem I will consider neuropsychological testing to specifically test memory, auditory comprehension, reading comprehension, and other integrative skills of the brain.

My treatment philosophy with children is mainly “let kids be kids.” Children are active, they tend to sleep more, and they can be moody. Sometimes parents’ concerns are based more on the parents’ experience with fibromyalgia and fear that the child may be going through the same thing.

I address these concerns and try to offer encouragement. I believe that minimal invasiveness is required. The main treatment may simply be a matter of reassuring the child and parent that there is no serious medical condition, but rather there is some evidence of fibromyalgia which can be handled with education, and tailoring an activity program to include stretches and specific exercises, nutritional approaches, and long-term monitoring.

Modifications for Treatment and School

If Dr. P. finds that the child with FM has functional impairment as a result of the illness, is missing school and missing sports activities or regularly attended functions, he will treat more aggressively.

Treatments could include specific, prescribed medicines such as klonopin [a sleep inducing, relaxing drug], nortriptyline [an antidepressant], or a mild pain medication. I may prescribe a therapy program to try to find out what works and to develop a successful home program. Nutritional strategies, education, manual therapy and stress management are other treatments to consider.

He suggests for school modifications to include rescheduling the student’s classes so that he/she may arrive later in the da.  He also recommends physical adaptation including using backpacks, luggage carts, avoiding steps by using the elevator, and having a locker on another floor so that large amounts of books don’t have to be carried at one time.   Lastly, he recommends that the suffering FM children need to be excused from gym class.

Sometimes it is necessary to temporarily remove the child from school and use a home tutor. If the process of getting to and from school is extremely difficult because of pain and fatigue, this may be a reluctant but necessary option.

Dr. Pellegrino says that the one thing about FM in children is that they are more adaptable to change than adults so it is easier for them to adjust than what it is for adults.  What he does want parents of FM children to know is:

Do not project their fears onto their child, because each child is unique and the fibromyalgia has a unique identity as well.  Even if the mother is having a difficult time with her fibromyalgia, the child can reach a stage where the FM is hardly a bother. Most of the children I’ve seen have done better over time, and I am hopeful that they will continue to do well.

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