title: Symptom clusters in children.
abstract: OBJECTIVE
  Researchers have focused on identifying and describing symptom experiences among children with various diseases but symptoms can have a synergistic and/or an antecedent effect that must be evaluated. This review reports the current knowledge of symptoms among various pediatric diseases and highlights symptom cluster research.
  
  
  RESULTS
  Symptoms of depression and anxiety are the most prevalent variables studied across pediatric disease studies followed by pain, fatigue, and quality of life. Although previous pediatric symptom research provides a foundation for understanding the complexities of these symptoms, there is limited evidence on symptom cluster research in pediatrics. Pain and fatigue are the most common symptoms analyzed for correlations, and relationships among symptoms that have been evaluated in children with juvenile idiopathic arthritis, HIV, cancer, cardiac disease requiring an implantable cardioverter defibrillator, and at end of life. Pain and fatigue have been associated with sleep disturbances, anxiety, depression, anorexia, and nausea/vomiting.
  
  
  CONCLUSIONS
  Pediatric oncology researchers are leading the way with symptom cluster studies; however, this work remains in the early stages. There is great potential to advance the state of the science with cluster analysis. Future research work should focus on evaluating symptoms and their interactions.
authors.affiliation: Baylor College of Medicine/Texas Children's Hospital, Houston, Texas 77030, USA.
authors.forename: Cheryl C
authors.initials: CC
authors.lastname: Rodgers
authors.forename: Mary C
authors.initials: MC
authors.lastname: Hooke
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Hockenberry
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000209:etiology; D002648:Child; D002908:Chronic Disease / Q000523:psychology*; D016206:Databases, Bibliographic; D003863:Depression / Q000209:etiology; D005221:Fatigue / Q000209:etiology; D006801:Humans; D055809:Illness Behavior; D010146:Pain / Q000209:etiology; D010372:Pediatrics; D011788:Quality of Life; D018434:Sickness Impact Profile; D012893:Sleep Wake Disorders / Q000209:etiology; D013577:Syndrome