Version May 2024
| Examination finding | Definition | Clinical concern raised |
| Anthropometrics | ||
| Short stature or unexplained decrease in height velocity | Height <50th percentile with weight >95th percentile* (if not explained by familial short stature) Growth velocity <5 cm/year in a prepubertal child, or declining across over 2 or more height percentile curves on a standard chart (eg, decreasing from the 90th to the 50th percentile) | Endocrine or genetic condition (eg, Cushing syndrome) |
| Vital signs | ||
| Hypertension | Hypertension if systolic or diastolic blood pressure >95th percentile for age, gender, and height on ≥3 occasions | Primary hypertension, kidney disease, or Cushing syndrome |
| Skin | ||
| Acanthosis nigricans | Hyperpigmented, thickened, velvety skin in body folds and creases, particularly neck | Suggests insulin resistance and increased risk for type 2 diabetes |
| Excessive acne, hirsutism, oligo- or amenorrhea | Hirsutism is an abnormal amount of sexual hair that appears in a male pattern (eg, face and neck) | Polycystic ovary syndrome |
| Violaceous striae | Linear lesions that are red, pink, or purple in color, particularly on the abdomen | Cushing syndrome |
| HEENT | ||
| Papilledema, cranial nerve VI paralysis | Optic disc swelling on funduscopic examination, caused by increased intracranial pressure | Pseudotumor cerebri (idiopathic intracranial hypertension) |
| Tonsillar hypertrophy | Tonsils occupy more than 50% of the lateral dimension of oropharynx | Obstructive sleep apnea |
| Goiter | Enlarged or swollen thyroid gland | Hypothyroidism |
| Chest | ||
| Wheezing | High-pitched whistling on auscultation | Asthma |
| Abdomen | ||
| Hepatomegaly, right upper quadrant tenderness | Increased liver span | Metabolic dysfunction-associated steatotic liver disease (previously known as nonalcoholic fatty liver disease) or gallstones |
| Genitourinary | ||
| Micropenis | Unusually small penis | In most cases, the small-appearing penis is actually normal size; the length is buried under suprapubic fat Some endocrinologic or monogenic forms of obesity are associated with hypogonadism and undervirilization in males |
| Undescended testes | Testicle not palpable in scrotum | Prader-Willi syndrome |
| Precocious puberty | Secondary sex characteristic development that is inappropriate for chronological age | Hypothalamic-pituitary lesion, including for ROHHAD/ROHHADNET syndrome Children with Prader-Willi syndrome often have premature pubarche (due to adrenarche) but not precocious puberty |
| Musculoskeletal | ||
| Abnormal gait, limp, pain in hip or groin, limited range of motion in hip | Slipped capital femoral epiphysis | |
| Genu varum (bow legs) or genu valgus (knock-knees) | Abnormal tibio-femoral angle | Mild deformities may be physiologic in children <6 years; in older children, these are associated with excessive weight Clinically significant genu varum is known as Blount disease |
| Small hands and feet, or polydactyly | Genetic condition (eg, Prader-Willi syndrome or Bardet-Biedl syndrome) | |
HEENT: examination of the head, eyes, ears, nose, and throat; ROHHAD/ROHHADNET: rapid onset of obesity, hypothalamic dysfunction, hypoventilation, autonomic dysregulation, with or without neural crest tumor.
* Most children with obesity who have not completed linear growth are relatively tall for their age. Therefore, height <50th percentile is unusual.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
