Pediatric Medicine

Answer 1 A dietary history should be elicited. This child is overweight. The initial steps in management include taking a detailed dietary history. In children, a dietary history is most useful for determining family eating and snacking habits, rather than for estimating caloric intake. About 1 in 4 children in the United States is overweight or at risk of being overweight, and this population is increasing.1 Overweight in children is defined as a BMI greater than 95th percentile for age and sex, as plotted on a growth chart. A child at risk for being overweight is defined as having a BMI over the 85th percentile and less than 95th percentile for age and sex on the growth chart. BMI is calculated as weight in kilograms divided by height in meters squared. The term “overweight” is preferred in pediatrics, instead of “obese,” because the relationship between BMI and body fatness is not as strong in children as it is in adults. Measurement of subcutaneous skin fold thickness is limited by the skill of the observer. Intervention to address this child’s weight problem would be indicated even in the absence of a family history of heart disease. In the presence of normal stature, it is rare for an endocrine disorder to be the cause of obesity in a child. REFERENCE 1. Dietz WH. Health consequences of obesity in youth: childhood predictors of adults disease. Pediatrics 1998;101(3 Pt 2):518-25. SUGGESTED READINGS 1. Committee on Nutrition, American Academy of Pediatrics. Pediatric nutrition handbook. 4th ed. Elk Grove Village (IL): American Academy of Pediatrics; 1998. 2. Lawrence RA, Lawrence RM. Breastfeeding: a guide for the medical profession. 5th ed. St. Louis (MO): Mosby; 1999. Click here to return to the questions

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