• Should a Child Who Is Always Tired Despite Adequate Sleep Be Evaluated by a Physician?

Child Who is Consistently Tired Despite Adequate Sleep Should Be Evaluated by Physician

November 16, 2012

Dear Mayo Clinic:

My 8-year-old is tired all the time even though she gets 11 to 12 hours of sleep a night. Is this part of growing up, or should I address it with her pediatrician? I wondered if she might be anemic, but I have read this is rare in children.


It is not uncommon for children to feel tired occasionally. Many factors can lead to tiredness. A busy schedule, not getting enough sleep at night and even being hungry can all make a child tired. But if a child is consistently feeling tired, especially when he or she is getting enough sleep, it is a good idea to talk about it with a pediatrician. In some cases, tiredness may be a sign of an underlying problem.

Being tired at the end of the day is normal for most children, especially those who are active. Children also may feed tired when they get hungry between meals. In those cases, all it usually takes to relieve their tiredness is a healthy snack. For many kids the best way to prevent daytime tiredness is a good night's sleep. Children generally need at least 10 hours of sleep a night to function best during the day.

Interestingly, school-age children do not usually complain of daytime tiredness or fatigue, even when they do feel a little tired. Instead, these concerns are more often noticed by a child's parents or caregivers. So when a child talks about being tired or shows obvious signs of fatigue, like lying down to rest in the middle of the day, for example, that should be taken seriously. It may point to an underlying medical condition that needs evaluation.

A variety of illnesses can cause a child to be tired. Most acute illnesses — for instance, upper respiratory infections like colds, or ear, throat or sinus infections — make children tired. But with these illnesses, the fatigue goes away when the infection clears.

More prolonged or significant tiredness could be a sign of allergies or asthma. Tiredness that lasts is the most common and prominent symptom of mononucleosis — often called "mono" — caused by Epstein-Barr virus. Fatigue that persists could also be related to poor sleep that results from a sleep disorder, such as obstructive sleep apnea.

Rarely, chronic fatigue may reflect a more serious underlying condition, such as tuberculosis, diabetes, inflammatory bowel disease, chronic kidney disease, heart failure, cancer or very poor nutrition. It also may indicate an emotional, educational or social problem.

As you mentioned, parents frequently bring up anemia as a possible cause of a child's tiredness. Anemia is a condition in which there aren't enough healthy red blood cells to carry adequate oxygen to the body's tissues. Tiredness can be a symptom of anemia. But unless it is quite severe, anemia is rarely the cause of persistent fatigue in children.

In your child's situation, I suggest first confirming that he or she is, indeed, getting at least 10 hours of restful sleep each night. Check to see if snoring, restlessness or other sleep disturbances may be interfering with healthy sleep. Make sure your child is eating a well-balanced diet with healthy snacks between meals.

Also, talk to your child about any difficulties he or she may be having at school or other social, emotional or learning problems that could be at play. Check for other symptoms of illness, allergies or asthma, too.

If changing sleep habits and diet does not help, or if you suspect a sleep disorder or other medical problem could be to blame for the fatigue, talk to your child's pediatrician about your concerns and have the situation evaluated.

— Chris Derauf, M.D., Community Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minn.

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