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What to do for a tired teenager

Q. Our 15-year-old daughter seems tired all the time, even though she seems to sleep a lot. Should I be concerned? What can we do to improve her energy level?

A. Fatigue is common during adolescence. Most tired teens are simply not getting enough sleep. Bedtime gets later with high school homework and extracurricular activities. Also, bio-rhythms change during adolescence. Melatonin, a hormone that promotes sleep, is secreted later in the evening for teens compared to younger children.

Add to all this the fact that teens are waking up around 6 a.m. thanks to early start times at high schools, and sleep deprivation becomes nearly inevitable. Teens on average require 9 hours of sleep per night, but most get 6 1/2 to 7 1/2.

Other possible causes:

Sleep disturbance: Conditions such as sleep apnea and restless leg syndrome affect the quality of sleep.

Medications: Certain medications, including some over-the-counter cold and allergy meds, may have drowsiness as a side effect. Parents must also consider the possibility of substance abuse.

Depression/anxiety: Fatigue is often an early sign of underlying depression or anxiety.

Anemia: Low iron levels in the blood can lead to anemia and fatigue. Teens who are vegetarian or vegan are at increased risk for anemia.

Other medical problems: Medical conditions such as mononucleosis and hypothyroidism may lead to fatigue. Each of these would have other symptoms and would not be suspected in an otherwise healthy teen.

It is also important to differentiate fatigue from loss of physical endurance. Most tired teens are still able to exercise and participate in sports without problems.

Parents faced with the challenge of a tired teen should begin by working on sleep hygiene, improving eating habits and starting a multivitamin. If symptoms do not improve with these changes, seek medical advice.