# Fatigue in pediatric inflammatory bowel disease: Explained by transdiagnostic and disease‐focused factors

## TL;DR

Fatigue is common in children with inflammatory bowel disease and is mostly linked to lifestyle and psychological factors rather than the disease itself.

## Contribution

The study shows transdiagnostic factors like sleep and mental health explain most fatigue variance in pediatric IBD.

## Key findings

- Severe fatigue was reported by 29% of children with IBD.
- Transdiagnostic factors explained 78% of fatigue variance in multivariate models.
- Disease activity and comorbidity had weaker associations with fatigue compared to transdiagnostic factors.

## Abstract

Fatigue is highly prevalent in children with inflammatory bowel disease (IBD), even during clinical remission. This suggests a role for transdiagnostic factors—lifestyle, psychological, and social influences not specific to the disease. This study aimed to assess the prevalence of severe fatigue in pediatric IBD and evaluate its associations with both IBD‐focused and transdiagnostic factors.

Children with IBD ages 8–18 from the PROactive cohort completed the Pediatric Quality of Life Inventory—Multidimensional Fatigue Scale. IBD‐focused clinical data were extracted from electronic health records. Transdiagnostic factors were assessed using validated patient‐reported outcome measures. Associations with fatigue were examined using linear regression.

Among 127 patients (mean age 14.9 ± 2.7 years; 43% male), most were in clinical remission. One hundred six patients self‐reported fatigue, and 99 parents reported their child′s fatigue. Severe fatigue was self‐reported by 29%. Of IBD‐focused factors, only disease activity (β = −0.40) and comorbidity (β = −0.18) showed significant associations with fatigue. Of transdiagnostic factors, lower physical, emotional, and social functioning; poorer sleep quality; less physical activity; more pain, anxiety, and depressive symptoms; lower life satisfaction and self‐rated health; and increased school absence and pressure were significantly associated with more fatigue. Backward selection retained only transdiagnostic factors in the multivariate model, which explained 78% of fatigue variance.

Fatigue is common in children with IBD and is more strongly associated with transdiagnostic than disease‐focused factors. These findings highlight the importance of integrative care strategies that address modifiable psychosocial and lifestyle domains to reduce fatigue and improve functioning in children with IBD.

What is Known

Fatigue is a common, debilitating symptom across chronic childhood conditions, including inflammatory bowel disease.Previous research shows a limited association between fatigue and clinical disease activity.

Fatigue is a common, debilitating symptom across chronic childhood conditions, including inflammatory bowel disease.

Previous research shows a limited association between fatigue and clinical disease activity.

What is New

Transdiagnostic factors such as sleep quality, depressive symptoms, and social functioning account for most fatigue variance.Targeting modifiable transdiagnostic factors may be key to reducing fatigue and its effect on daily functioning.

Transdiagnostic factors such as sleep quality, depressive symptoms, and social functioning account for most fatigue variance.

Targeting modifiable transdiagnostic factors may be key to reducing fatigue and its effect on daily functioning.