The first step in properly treating children with CFS is making the diagnosis. There is a great body of knowledge available about how children cope with chronic illness, and identifying a reason for their poor health will help them cope with it in an emotionally healthier way.

Failure to establish the diagnosis and lack of cooperation between professionals may lead to inaccurate impressions that the child is malingering or "faking." This may result in isolation, insecurity, sense of failure, family stress and even legal action against the family by school authorities. Further, an unresolved diagnosis may leave the child with uncertainty as to whether he or she is really experiencing the symptoms, or whether they are "all in the mind," as skeptics claim.

Otherwise, treatment for children varies little from that for adults and is intended primarily to relieve specific symptoms. Treatment must be carefully tailored to meet the needs of each patient. Sleep disorders, pain, gastrointestinal difficulties, allergies, dizziness, light-headedness, blood pressure irregularity and depression are some of the symptoms which physicians commonly attempt to relieve with prescription and over-the-counter medications. Children with CFS may have unusual responses to medications, so low dosages should be tried first and gradually increased as appropriate.

Treatment is otherwise largely supportive and responsive to symptomatology. This includes physical therapy and modest aerobic or anaerobic exercise (if possible) to avoid cardiovascular de-conditioning. Sleep may be addressed with medication; often, melatonin or night-time amitriptyline is helpful. If present and severe, pain is often addressed in a pain clinic. Headache may be successfully treated with anti-migraine therapy, and biofeedback regimens have been helpful at times. If concurrent with orthostatic intolerance, headache may be amenable to measures designed to improve blood flow and blood pressure. Fatigue and neurocognitive defects are harder to address. Some clinicians have used stimulants with some success.

Lifestyle changes, including increased rest, reduced stress, dietary restrictions, nutritional supplementation and light exercise (such as walking) also are frequently recommended. These changes will likely impact a young person's educational and social experiences, and their long-term impact must be considered. Supportive therapy, such as counseling, can also help a young person with CFS identify and develop effective coping strategies. Chronic illnesses such as CFS are traumatic for the child's family as well as the child, and support from school officials, physicians and friends is important.