Monitoring

Your Organizational Guidance

ebpracticenet urges you to prioritize the following organizational guidance:

Obesitas bij kinderenPublished by: Domus Medica | SSMGLast published: 2008Obésité chez l'enfantPublished by: Domus Medica | SSMGLast published: 2008

Body mass index (BMI) should be calculated and plotted at each visit to monitor for effects of treatment. Blood pressure should be monitored routinely.[3]​ Monitoring of psychosocial function and using an evaluation tool when a patient presents with symptoms of depression is also advised.[3]

As per the American Diabetes Association recommendations, risk-based screening for prediabetes and/or type 2 diabetes mellitus should be considered after the onset of puberty or after 10 years of age, whichever occurs earlier, in children and adolescents with a BMI ≥85th percentile who have one or more risk factors for diabetes mellitus. Risk factors include maternal history of diabetes mellitus or maternal gestational diabetes during the child’s gestation; family history of type 2 diabetes mellitus in first- or second-degree relative; Native American, African American, Latino, Asian American, Pacific Islander race/ethnicity; signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome, or small-for-gestational-age birth weight). Screening should include fasting blood glucose, a 2-h plasma glucose during a 75-g oral glucose tolerance test, or hemoglobin A1c level checked at a minimum of every 2 years or more frequently if BMI is increasing or risk factor profile is deteriorating. Reports of type 2 diabetes mellitus before age 10 years exist, and screening can be considered with numerous risk factors.[3][77][78]​ In addition, when considering type 2 diabetes mellitus screening, panel of pancreatic autoantibodies should be tested to exclude the possibility of autoimmune type 1 diabetes mellitus.[78] Fasting lipoproteins and liver function tests should also be checked routinely. The American Academy of Pediatrics expert committee suggests screening for lipid abnormalities, abnormal glucose metabolism, and abnormal liver function every 2 years starting at 10 years of age for children with BMI of 95th percentile and those with BMI of 85th to 94th percentile who have other risk factors.[3]​​

In children ages 10 or over who are overweight (BMI 85th to 94th percentile) consider screening for lipid abnormalities.[3]

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