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
Additional investigations Cushing's syndrome :
to be done if clinically 24-hour urinary cortisol
Dexamethasone supression test
Chromosome analysis for Prader-Willi syndrome
Non-alcoholic steatotic hepatitis:
Blood aminotransferases
Liver ultrasound scan
Polycystic ovarian syndrome:
Sex hormone binding globulin
Luteinising hormone (LH)
Follicle stimularing hormone (FSH)
Dihydroepiandrostenedione (DHAS)
17-hydroprohesterone (17-OHP)