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