Pediatrics

Dubai Pediatric Clinic

Not all children carrying extra kilograms are overweight or obese. So you might not know just by looking at your child if a weight is a healthy concern.

If you are worried that your child has extra weight, talk to his doctor. Your child’s doctor will consider the child history of growth and development, family history, and where your child lands or the growth chart and his BMI. This can help determine if your child’s weight is unhealthy. 

BMI: Body Mass Index is the accepted measure of overweight and obesity. 

BMI = weight/kg

          (Length) 2/cm 

BMI between 85th – 94th is overweight.

BMI 95th percentiles and above is obesity.

CAUSES

  • Most cases of obesity are result of lifestyle issues, too little activity and lack of exercise, regularly eating high calorie foods such as fast food, candy and desserts, sugar drinks.
  • Studies shows that if the child comes from a family of overweight people he will be at risk of obesity and family stress can increase a child’s risk of obesity.
  • In 10% cases of obesity, we can find a genetic of hormonal problems.

GENETIC SYNDROMES WITH OBESITY

  1. BARDET BIEDL – Polydactyly, obesity, hypogonadism, kidney abnormalities, autosomal recessive. Diabetes, increase blood pressure, Hirschsprung disease, Speech and language problems, Behavior disorder, dental abnormalities.
  2. PRADER WILLIS – is a genetic condition in infancy. This condition is characterized by weak muscle tone, feeding difficulties, poor growth, and delayed development in childhood. Affected individuals develop an insatiable appetite which leads to chronic over eating and obesity. Some of them develop type 2 diabetes.
  • They have intellectual impairment and learning disabilities, behavior problems, sleep abnormalities, distinctive facial features as a narrow forehead, triangular mouth, and small hands and feet.
  • Both males and females have underdeveloped genitals, delayed puberty and infertility.
  1. PSEUDOHYPOPARATHYROIDISM - is a genetic disorder in which the body fails to respond to parathyroid hormone. PTH helps control calcium, phosphorus and Vitamin D in the blood and bone. The symptoms are: cataract, dental problems, seizure, numbness, tetany, calcium deposits under the skin, round face and short neck, short hand bone, short height and obesity.
  2. LAURENCE MOON SYNDROME – is a rare condition that affect many different parts of the body and include cerebellar ataxias, eye abnormalities, peripheral neuropathy, spastic paraplegia (weakness and stiffness of the leg); intellectual disability, short stature (hypopituitarism). Mutation in PNPLA6 gene inherited in an autosomal recessive manner.
  • Finger syndactyly, hand polydactyly, intellectual disability, obesity, and cryptorchidism. Hypoplasia of penis, renal insufficiency, sensorial hearing impairment, abnormal in cardio vascular system morphology.
  1. DOWN SYNDROME – genetic disorder caused by the presence of all part of a third copy of chromosome 21. They have a characteristic facial feature, mild to moderate intellectual disability.
  • The symptoms are: mental impairment, increased skin back of neck, low muscle tone, flat head, flexible ligament, abnormal outer ear, slanted eye, flat nose, congenital heart disease, obesity, problems in thyroid gland, hypoparathyroidism.
  • In genetic syndrome, the diagnosis is made by genetic studies. 

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ENDOCRINE DISEASE AND OBESITY 

  1. HYPOPARATHYROIDISM - deficiency of thyroid hormone can cause fatigue, cold intolerance, dry skin, hair loss, sleepiness, gain weight, constipation, and depression. Diagnosis is by measuring thyroid hormones TSH and FTH and the treatment reserve most of symptoms and help to achieve growth and weight appropriate for age.
  2. GROWTH HORMONE DEFICIENCY – the child with GH deficiency often has short stature and obese, and they have delayed bone age showed by hand bone xray.
  • The diagnosis is made by measuring GH hormone after stimulation by giving decrease insulin, argenin, and glucagon.
  • The pituitary gland produces GH in bursts. The treatment is by injection of growth hormone to increase growth rate.
  1. CUSHING DISEASE – is caused by tumor or hypoplasia of the pituitary gland that increases adrenocorticotropic hormone and that stimulates production and release of cortisol from adrenal gland.
  • The symptoms are weight gain, high blood pressure, excess hair growth(women), extra fat around the neck, moon face, impaired immunological function, red stretch mark, acne, and poor concentration.
  • Diagnosis is made first by measuring plasma cortisol, Rh adrenal CT, dexamethasone suppression test.
  • Treatment is surgical resection of ACTH. Dissecting pituitary adenoma or tumor.
  • Precocious puberty is considered precocious if it starts in girls younger than 8 years of age and boys less than 4years.
  • The cause of precocious puberty is diagnosed by hormone analysis and abdominal ultrasound and brain MRI. For central precocious puberty treatment is necessary to achieve the optimal height in the child.
  1. POLYCYSTIC OVARY – Girls with PCO has obesity, excess hair growth in adolescents, infrequent or absent menstruation.
  • The diagnosis is made by ovarian ultrasound and hormone test which includes thyroid function, prolactin, testosterone, HCG, 17 hydroxyprogesterone, insulin like growth factor, FSH, LH lifestyle modification. Diet and exercise and weight loss improve the case. The treatment includes contraceptive antiandrogen, hypoglycemic agent.
  1. PROLACTIN SECRETING TUMOR- Decreased menstruation, amenorrhea, producing breast milk and diagnosed by measuring serum prolactin and pituitary CT. The treatment is surgical with dopamine agonist drugs.
  2. TURNER SYNDROME – is a chromosomal condition that affects development in female. The patient may ask medical advice for short stature. The doctor can find some physical feature of webbed neck, low hair line at the back of the neck, puffiness and swelling of the hand and feet and in the future these girls have ovarian hypofunction with delayed signs of puberty.

Clinical clue that suggest a hormonal etiology of obesity:

  • Short stature
  • Dry skin, constipation, cold intolerance
  • Inappropriate sexual development in an early age
  • Headache, vomiting, visual disturbances

Obese child with these symptoms should investigate for endocrine problems.

Dysfunction of the gut-brain-hypothalmic axis via the ghrelin / leptin hormonal pathway have a role in abnormal appetite and lead to excess energy intake and obesity.

Approach consideration:

  • Identify any genetic or hormonal disorder that maybe a cause of obesity.
  • Standard laboratory studies should include:
  • Fasting lipid panel
  • Liver function studies
  • Thyroid function test
  • Fasting glucose and HbAIc

Other tests are performed as indicated by clinical finding:

  • Serum leptin
  • Adrenal function test
  • Karyotype
  • Growth hormone secretion and function test
  • Assessment of productive hormones and prolactin
  • Serum Ca, phosphorus, parathyroid hormone levels.
  • MRI of the brain.

COMPLICATION OF CHILDHOOD OBESITY

  • Obese child have a big chance to be obese adult and to have Type 2 diabetes, hyperlipidemia, accelerated growth and bone maturation, ovarian hyperandrogenism and gynecomastia, cholecystitis, pseudo tumor cerebri, fatty liver, sleep apnea, sleep disorder.
  • Orthopedic disorder, slipped capital femoral epiphysis, tibia vara, bowing of the tibia and femur.
  • Emotional and psychosocial sequel are widespread, depression, low self-steam and social isolation.
  • Obesity is associated with several cardio vascular risk factor, high glucose, high HDL and hypertension.

MANAGEMENT:

  • Family –based behavioral weight control is effective in severe cases of obesity and any intervention is likely to fail if it does not involve the active participation and support of family members.
  • Lifestyle modification, exercise and physical activity
  • Reduce intake of free sugars to less than 10% of total energy intake.
  • Reduction in total and saturated fat to 30% of total energy intake.

PREVENTION:

  • Identify young children who are predisposed to adolescent and adult obesity
  • Learning lifelong habit that incorporates exercise and healthy eating is essential

 

Dubai Pediatric Clinic at Dr Rami Hamed Center provides one of the best pediatrician in dubai .

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