Fatigue and lethargy in children and adolescents — formative SAQs

SAQ 1 (10)

A 4-month-old is brought to ED. Parents say the baby is "very tired" and has fed poorly for 12 hours. Temperature is 38.6°C. The infant has reduced eye contact and a weak cry. ^[4]

1. Distinguish fatigue from lethargy in this age group and state your immediate priority. (3) ^[4]
2. List five must-not-miss causes of infant lethargy. (3) ^[1]
3. Outline your first 10 minutes of assessment and management principles (no invented drug doses). (4) ^{[4] [6]}

Model answer

Fatigue vs lethargy. Fatigue implies reduced energy with preserved interaction. This infant has reduced interaction — lethargy emergency language. Immediate priority is ABCDE threat assessment, not a chronic-fatigue interview. ^[4]

Must-not-miss examples. Sepsis; meningitis/encephalitis; hypoglycaemia; cardiac failure/myocarditis; raised intracranial pressure or trauma/non-accidental injury; severe anaemia; metabolic crisis; intoxication. (Any five high-threat items scored.) ^[1]

First actions. Open assessment of airway, breathing, circulation, disability with glucose, exposure; senior help; sepsis-capable pathway if infection likely; parallel history; early escalation if local capability exceeded; clear safety-net only after stabilisation and disposition decision. ^{[4] [6]}