Fatigue is a debilitating symptom and can significantly compromise quality of life. Patients may not complain of fatigue as many consider it a part of the disease process and not amenable to therapy. It is important however, not to accept fatigue as a part of terminal illness before actively considering and addressing potentially reversible factors including;

• Anaemia 
• Depression
• Malnutrition
• Dehydration
• Insomnia
• Medications: opioids, sedatives etc

Treatment should be aimed at correcting any of the above causes where appropriate. For many patients, fatigue will reflect disease progression and support will focus on helping the child and family adjust their expectations and goals. Whilst rest is helpful, too much may worsen fatigue and planned activities may improve the child's sense of well-being. In this way, it may be helpful for the family to plan activities around the fatigue. School attendance for example may be reduced to short periods for favourite classes at times when the child is feeling most energetic.

Fatigue does not respond well to pharmacological therapy. Steroids may produce an enhanced sense of well being but this is short-lived and often associated with distressing side effects such as mood and behaviour changes and marked weight gain.