When should a child be referred to a paediatrician?
A child should be referred to a paediatrician when there is a suspected pathological cause to their obesity. This would be determined by coexisting signs or symptoms in the child:
- Height below ninth centile, shorter than expected for family
- Slow growth velocity
- Precocious (before 8 years) or late puberty (no signs at 13 in girls or 15 in boys)
- Any child suspected to have any of the complications of obesity
- Any child that becomes obese in the first two years of life.
The following table summarises the investigations that would take place following a paediatric referral.
| Investigations following paediatric referral | |
|---|---|
| All obese children | Oral glucose tolerance test: |
| Fasting insulin | |
| Fasting lipids | |
| Liver function | |
| Thyroid function | |
| Calcium | |
| Additional investigations | Cushing's syndrome : |
| to be done if clinically | 24-hour urinary cortisol |
| Dexamethasone supression test | |
| Genetic: | |
| Chromosome analysis for Prader-Willi syndrome | |
| Non-alcoholic steatotic hepatitis: | |
| Blood aminotransferases | |
| Liver ultrasound scan | |
| Polycystic ovarian syndrome: | |
| Testosterone | |
| Sex hormone binding globulin | |
| Luteinising hormone (LH) | |
| Follicle stimularing hormone (FSH) | |
| Dihydroepiandrostenedione (DHAS) | |
| 17-hydroprohesterone (17-OHP) | |
| Androstenedione | |