Obesity in children

Specialty: Children's medicine
Age group: Children

Direct to an emergency department

• Rapid progression of obstructive sleep apnoea with significant parental concerns
• Suspected or confirmed slipped upper femoral epiphysis (SUFE).

Criteria for referral to public hospital service

• Child with body mass index greater than ninety-fifth percentile and at least one of the following
  • abnormal liver function tests, defined as alanine aminotransferase (ALT) greater than or equal to 2 times the upper level of the normal range
  • HbA1c greater than 39 millimoles per mole or 5.7 percent
  • hyperlipidaemia, defined as total cholesterol greater than 6 millimoles per litre or low-density lipoproteins (LDL) greater than 3.5 millimoles per litre
  • hypertension, defined as greater than 95 percent for age, sex and height, measured with an appropriate size cuff
  • neurodiversity
  • developmental regression, developmental delay or physical disability
  • sleep disordered breathing that persists for more than 3 months that is impacting on the child’s behaviour, ability to attend school, or is impacting on family life.

Information to be included in the referral

Information that must be provided

• Reason for referral and expectation or outcome, anticipated by the patient, or their carer, and the referring clinician from referral to the health service
• Age
• Findings on physical examination
• Blood pressure measurements, preferably taken on both arms
• Growth charts, including current height, weight and head circumference (indicate if these measurements cannot be provided due to the child’s sensory sensitivity or behavioural issues)
• Body mass index (BMI)
• Relevant medical history and psychosocial risks that may be linked to the child’s obesity such as polyendocrine metabolic ovarian syndrome (PMOS) (or polycystic ovarian syndrome), maternal gestational diabetes, family violence, parental mental health issues, homeless or at risk of homelessness, the child lives in out-of-home care, signs of abuse or neglect
• The functional or psychological impact on quality of life or activities of daily living including impact on work, study or social activities
• If abnormal liver function tests, current and historical liver function tests
• If impaired glucose tolerance, current and previous HbA1c results
• The child’s neurotype
• Details of any developmental or physical disability
• If sleep disordered breathing, if the child has been referred to a sleep, respiratory or ENT service
• If sleep disordered breathing, full report of most recent sleep investigation or description of onset, nature, progression, recurrence and duration of symptoms (somnolence, snoring, witnessed apnoea, restless sleep, unrefreshing sleep, tiredness)
• Summary of oral intake, food behaviour and dietary practices (e.g. dietary restrictions, acceptance of food, trauma or neglect, food insecurity)
• Details of previous management including the course of treatment(s) and outcome of treatment(s)
• Any relevant weight gain or growth family history including comment on parental obesity and genetic weight for height proportions.

Provide if available

• Any relevant pathology test results (e.g. Free thyroxine (T4) results and thyroid stimulating hormone level (TSH))
• If the child identifies as an Aboriginal and/or Torres Strait Islander
• If the child is gender diverse
• If the child has a disability
• If the child has a preferred language other than English and if they rely on cultural or linguistic support (e.g. Aboriginal cultural support, an interpreter)
• If the child lives in out-of-home care (foster care, kinship care, permanent care or residential care)
• If the child is a refugee, seeking asylum or has a bridging visa while waiting for an immigration outcome
• If the child is aged 14-18 years, do they consent that their health information is shared with their parent, guardian or carer.

Additional comments

The Minimum information for referrals to non-admitted specialist services lists the information that should be included in a referral request.

Note there are statewide referral criteria for children for Sleep disordered breathing, Assessment of atraumatic hip conditions in children and Assessment of atraumatic knee conditions in children

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

• Overweight children without any complications or comorbidities.