Fatiguing illinesses are often confused with other conditions, and especially with various emotional problems.  How can you effectively advocate for your child when school or doctor is making this kind of mistake?

The most frequent accusation is School Phobia.  Some school phobic children are afraid of school for one reason or another.  Most, however, are afraid to be away from home.   In either case the child gets sick at school and is well when at home.  If a child is ill at home, or gets ill when she goes out to play with her friends, or gets ill from the exertion of a family outing, the problem is NOT school phobia.

Social Phobia (or social anxiety) is a fear of being with groups of people, both strangers and family members.  Social phobics may also fear all strangers.  If a child avoids or seems ill at ease in family gatherings of five or more people, or won't go out of the house alone, won't go into a well known store alone, or won't play with groups of children, he might have social phobia.  If a child is okay with groups, is able to go outside alone when there might be strangers nearby (on the sidewalk, for instance), or will do an errand in a nearby store, the problem is NOT social phobia.

Depression is a mood disorder.  If there isn't a bad or low mood, there is no depression.  The depressed person feels sad even in pleasant circumstances, is often tearful for no particular reason, does not enjoy normally pleasurable activities.  There is also a loss of motivation;  the depressed child does not want to do such normal things as get out of bed or go out and play.  If a sick child wants to do things, but can't because of the illness, but does enjoy activities when he is well enough to do them, is not sad except about things it is normal to be sad about (missing school, for instance), and does not cry except over things reasonable to cry about, the problem is NOT depression.

Anxiety is the medical word for unreasonable fear.  If a child is afraid of a large, aggressive, and unfriendly dog, that's not anxiety.  If he is afraid of all dogs, not matter how small and friendly, that is anxiety.  Some children suffer from what used to be called overanxious disorder.  This is now part of Generalized Anxiety Disorder, but the overanxious name is still a very apt description of the child who worries excessively about everything.  Overanxious children often have bodily symptoms, particularly stomach aches and headaches.  They may experience diahrrea or constipation, sleep poorly, have appetite problems, even worry themselves into low grade fevers.  If a child has a lot of physical complaints but is not fearful, and does not worry unrealistically, she does NOT have an anxiety problem.

Malingering means deliberating avoiding work or school.  A child who invents a headache to get out of school is malingering.  Probably most children do this occasionlly.  I know I did (though I usually didn't get away with it).  Very few children malinger more than occasionlly.  Those who do unquestionably suffer from some kind of serious emotional disorder and should be seen professionally.  If a child tries (to go to school, to do homework) but fails, that is NOT malingering.

Children with fatiguing illnesses are often called "lazy."   Some children are more active that others, and they certainly like to do some things (such as play) more than others (such as chores), but laziness itself is not natural in children (or adults either).  Calling a child lazy just puts a label on a problem that needs to be understood.

People will also say of a sick child, "He's exaggerating."  That's so easy to say about someone else's pain and fatigue! Granted, a child might exaggerate a pain to get something for himself--for a while.  But if pain and fatigue keep a child from doing the things things he himself wants to do, he's NOT exaggerating.

Munchausen Syndrome is sa bizarre condition in which a person deliberating makes himself sick, in order to get medical treatment, including major operations.  It is a rare but very serious and quite dangerous illness.  There are a few documented cases of parents (usually mothers) making a child ill in order to have the child get medical treatment.  This is called Munchausen Syndrome by Prozy or MBP. When it occurs it is a form of child abuse and leads immediately to removal of the child from the care of the parent.  I personally know mothers of children with Chronic Fatigue Syndrome who have been formally but unfairly accused of Munchausen, and who did lose control of their children for a period of time.  My wife has also been accused by a physician of MBP but (luckily) in an informal way that did not lead to legal action.  This kind of accusation is a huge danger when a child is sick without a clear cause (and very few of the fatiguing illnesses have clear causes).  For more information, see the website for Mothers Against Munchausen Sydrome by Proxy Allegations.

If you can think of other conditions which should be discussed here, let me know.