Q: Our 10-year-old has not been herself since school started. She's usually full of energy and eager to talk. Now she doesn't want to go to her dancing lesson or to soccer practice, even though she loved to this summer. She wants to go to bed even before she finishes her homework. She says things are fine at school, she's just tired. I'm worried she's sick.
A: We are inclined to think the answer lies with your daughter's mental, rather than her physical, health. The fact that your daughter's behavior changed when school started may be an important clue. Sitting down with your daughter more than once to listen to her concerns may give you additional leads.
We suggest you think about your daughter's schedule. Is she tired because she is too busy? Children are sometimes in so many activities out side of school, they just wear out. They need time for relaxation and rest. As children enter the rapid growing period that comes with the onset of puberty, their sleep requirement often goes up. In short, your daughter may be tired because she is being asked to do too much. An overly full or chaotic schedule could be affecting her physically or mentally or both.
Your daughter may have worries that are taking a toll on her energy level and her interest in activities. Something may be wrong at school, even if she denies it. If gentle prodding doesn't uncover anything, check with your daughter's schoolteachers to see if they are aware of anything that might be troubling her. It is important to ask whether she is lively and interested at school. Remember that problems can originate both in and out of the classroom. Issues that seem small to you may seem quite large to your daughter. Compare school to a job, and think how often adults let anxieties about work follow them home!
Could an illness be making your daughter tired? Certainly, but it would be unusual for an illness to cause fatigue without other signs. Her doctor can reassure you that she is physically well with a thorough history and physical examination. In fact, we believe your child's doctor will be a valuable partner in helping you sort this out.
Dr. Wilson is director of general pediatrics at Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.