Rangel, L, Garralda, M E, Levin, M et al. · Journal of the Royal Society of Medicine · 2000 · DOI
This study followed 25 children with severe chronic fatigue syndrome for about 3.5 years after their illness began. Most children (two-thirds) eventually recovered and returned to normal activities, though the illness caused serious problems during its worst phases, including extended time out of school. The researchers found that children who had a clear physical trigger for their illness, started feeling sick in the autumn, or came from higher-income families were more likely to recover.
This study offers important prognostic information for pediatric ME/CFS patients and families by demonstrating that most severely affected children can recover, while also identifying specific factors associated with better outcomes. Understanding these prognostic indicators helps clinicians counsel families about likely disease trajectories and may guide clinical management decisions.
This study does not prove that psychiatric factors cause or maintain CFS in children, despite recruitment from psychiatric clinics—the association between identified physical triggers and recovery suggests biological factors may be important. The findings may not generalize to all children with CFS, as the cohort was referred to tertiary psychiatric services, which may represent a selected population. The study cannot establish causation for the identified prognostic factors (e.g., whether higher socioeconomic status directly improves recovery or correlates with access to better medical care).
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Rangel, L, Garralda, M E, Levin, M, & Roberts, H (2000). The course of severe chronic fatigue syndrome in childhood.. Journal of the Royal Society of Medicine. https://doi.org/10.1177/014107680009300306
BibTeX
@article{mecfsatlas-rangel-2000-course-severe,
author = {Rangel, L and Garralda, M E and Levin, M and Roberts, H},
title = {The course of severe chronic fatigue syndrome in childhood.},
journal = {Journal of the Royal Society of Medicine},
year = {2000},
doi = {10.1177/014107680009300306},
note = {PubMed: 10741312},
url = {https://www.mecfsatlas.com/evidence/rangel-2000-course-severe},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/rangel-2000-course-severe
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