Case 4 - CLIPP - 8 yo well child check

Question 1

Definition of childhood obesity by percentile

Answer 1

> 95th percentile BMI

Question 2

Definition of overweight by percentile BMI

Answer 2

85-95 percentile BMI = overweight

Question 3

Percentage of obese 6-19 year olds?

Answer 3

15%

Question 4

Risk factors for childhood obesity

Answer 4

Genetic (prader-willi), high birth weight, maternal diabetes, fam hx, environmental (low SES, lack of safe places for physical activity)

Question 5

Sequelae of childhood obesity

Answer 5

HTN, OSA, restrictive lung disease (NOT reactive airway dz), diabetes, fatty liver, SCFE, Blout disease

Question 6

ADHD epidemiology

Answer 6

prevalence 8-20%

Question 7

ADHD diagnosis

Answer 7

based on symptoms of inattention, hyperactivity and impulsivity

Question 8

Diabetes breakdown in children

Answer 8

19% of diabetes is type 2

Question 9

Diagnosis of diabetes in kids

Answer 9

sx of diabetes + random glucose >200, or fasting glucose >126 of 2 hr serum glucose >200

Question 10

Screening for diabetes guidelines

Answer 10

Kids who are overweight (>85th percentile for BMI, or weight:height) or weight >120% ideal plus fam hx, non-white, or signs of insulin resistance, screen starting at 10 yrs every 2 years by fasting glucose

Question 11

HTN in children screening

Answer 11

measure every three years

Question 12

HTN classification in children

Answer 12

99+5 mm Hg: Stage 2 HTN

Question 13

Vaccination for kids

Answer 13

Follow vaccination schedule, flu every year, Hep a at 12 and 18 months

Question 14

Diff dx for ADHD

Answer 14

sensory impairment, sleep problems, mood disorder, learning disability, opposition defiant disorder

Question 15

Weight management for overweight children

Answer 15

Weight maintenance of slowing of weight gain until BMI <85 th percentile

Question 16

Weight management for obese children

Answer 16

Weight maintenance or weight loss (not more than 1 lb per month for pre teen, per week for adolescents), follow up every 3-6 months, make diet and physical activity recommendations

Question 17

PreHTN management

Answer 17

lifestyle changes, ask school nurse to record BP, follow up in 6 mo, avoid meds unless end organ effects or consistently high

Question 18

ADHD management

Answer 18

80% respond to stimulants

Question 19

Adverse effects of stimulants in children

Answer 19

weight loss, insomnia, tics, decrease in growth velocity, cardiovascular risks