Fatigue and lethargy in children and adolescents — OSCE

Station brief (candidate)

• Distinguish ordinary convalescent fatigue from red-flag disease.
• Take a focused history (sleep, snoring, mood, menses if relevant, post-exertional pattern, bone pain, fever).
• Explain which examinations and tests you will do and why.
• Agree a staged plan: treat reversible causes, energy management if indicated, school plan, review timing.
• Safety-net specifically. Avoid blame and avoid forced exercise as a universal prescription. [1] [2] [5]

Role-player notes

You are a worried parent. Your teenager sleeps poorly, tried to return to full sport too fast, and crashed for two days. A previous clinician said "push through." You become defensive if blamed, and cooperative if the doctor explains mechanisms and a paced plan. The young person wants to be believed. [2] [7]

Expected candidate performance

1. Opening: "Tiredness after a viral illness is common, but we still check for treatable and serious causes, then plan recovery without forcing crashes." [1]
2. History: Tempo, sleep/snoring, mood, menses, post-exertional pattern, red flags for malignancy or cardiorespiratory disease. [1] [3] [4]
3. Plan: Directed exam and tests (for example FBC/iron when indicated); OSA pathway if snoring; energy management if ME/CFS features; school liaison; review date. [2] [3] [4]
4. Safety-net: Return if reduced interaction, breathing difficulty, severe headache/vomiting, bruising/bleeding, or parental concern the child is worse. [5]
5. Communication: Believe the symptom, avoid "all in the mind," use teach-back; interpreter if language discordance. [6] [7]

Marking domains

• Threat versus convalescent reasoning.
• Directed investigation without shotgun testing.
• ME/CFS-aware energy plan without GET dogma.
• School and safety-net specificity.
• Trauma-informed, non-blaming communication. [2] [5] [7]

Common fails

• "Just push through training no matter the crash."
• Immediate chronic label with no red-flag screen.
• No follow-up date.
• Dismissing the young person's experience. [2] [1]