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#ir #peds
History
• What concerns, if any, do you have about your child’s weight? When
did weight gain start? Has gain been slow over time or sudden?
• What, if any, past attempts at weight loss have been made?
• Review of systems for comorbidities and etiologies of obesity:
o Headaches, blurred vision (hypertension, intracranial
hypertension)
o Breathing pauses when sleeping, snoring, daytime sleepiness (OSA)
o Joint pain (slipped femoral capital epiphysis, blount disease)
o Menstrual history, hirsutism, acne (hyperandrogenism, PCOS)
o Polyuria, nocturia (T2DM)
o Increased fatigue, cold intolerance, constipation, dry skin
(hypothyroidism)
o Stunted growth, striae (Cushing’s)
• Family History
o Identify obesity in first degree relatives
o Evaluate history of cardiovascular disease, type 2 DM, cancer in
first degree or second‐degree relatives
• Diet
o Identify caretakers who feed the child
o Identify foods high in calories and low in nutritional value that can
be reduced, eliminated, or replaced
o Assess eating patterns (e.g. timing, content, location of meals and
snacks)
o Estimate the type and quantity of beverage intake (sugar
sweetened beverages, juice, pop)
o Frequency of dining out
• Activity
o Identify barriers to walking or riding a bike to school
o Evaluate time spent in play
o Evaluate school recess and physical education (frequency, duration
and intensity)
o Assess after‐school and weekend activities
o Assess screen time (television, computer, movies, video games)
• Assess psychological impact of weight on child (bullying, depression,
anxiety, social isolation etc.)
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Growth
#13; ‐ Obese – BMI > 99.9th o 5 to 19 years ‐ Overweight – BMI > 85th ‐ Obese – BMI > 97th ‐ Severely obese – BMI > 99.9th • Over 60% of overweight children will have at least one CV risk factor <span>History • What concerns, if any, do you have about your child’s weight? When did weight gain start? Has gain been slow over time or sudden? • What, if any, past attempts at weight loss have been made? • Review of systems for comorbidities and etiologies of obesity: o Headaches, blurred vision (hypertension, intracranial hypertension) o Breathing pauses when sleeping, snoring, daytime sleepiness (OSA) o Joint pain (slipped femoral capital epiphysis, blount disease) o Menstrual history, hirsutism, acne (hyperandrogenism, PCOS) o Polyuria, nocturia (T2DM) o Increased fatigue, cold intolerance, constipation, dry skin (hypothyroidism) o Stunted growth, striae (Cushing’s) • Family History o Identify obesity in first degree relatives o Evaluate history of cardiovascular disease, type 2 DM, cancer in first degree or second‐degree relatives • Diet o Identify caretakers who feed the child o Identify foods high in calories and low in nutritional value that can be reduced, eliminated, or replaced o Assess eating patterns (e.g. timing, content, location of meals and snacks) o Estimate the type and quantity of beverage intake (sugar sweetened beverages, juice, pop) o Frequency of dining out • Activity o Identify barriers to walking or riding a bike to school o Evaluate time spent in play o Evaluate school recess and physical education (frequency, duration and intensity) o Assess after‐school and weekend activities o Assess screen time (television, computer, movies, video games) • Assess psychological impact of weight on child (bullying, depression, anxiety, social isolation etc.) Physical Exam • Obtain and plot weight, height, BMI on WHO Growth Charts for Canada Complete physical exam • Findings to look for o Hypertension o En


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