Obesity and Hypertension in Children

Question 1

What are the risk factors for childhood obesity?

Answer 1

Obese parents 
Poor diet 
Low exercise 
Sleep deprivation – low leptin levels 
Low socioeconomic background 
Medication – sodium valproate, carbamazepine, mirtazapine, steroids
High or low birth weight
Maternal diabetes

Question 2

What can cause childhood obesity?

Answer 2

Hypothyroidism
Cushing’s syndrome
Growth hormone deficiency
Prader Willi syndrome

Question 3

How should obesity be investigated in children?

Answer 3

UK-WHO chart for children under 4
BMI chart for children over 4
If above 91st centile for weight then overweight, if above 98th then obese

Question 4

How should obesity be managed in children?

Answer 4

Agreement from parents that child is obese
Diet improvement
Increase in exercise
Referral to dietician

Question 5

What are the important complications of childhood obesity that parents should be made aware about

Answer 5

Insulin resistance 
Diabetes 
Sleep apnoea
Orthopaedic problems 
Non-alcoholic fatty liver disease 
PCOS 
Vitamin deficiencies

Question 6

What is the definition for hypertension in children?

Answer 6

No set definition – but general definition is above 95th centile for gender, weight, height and age. White coat hypertension is just as common in kids as adults so ambulatory BP monitoring may be used.

Question 7

What are the risk factors for hypertension in children?

Answer 7

High salt intake, obesity and low birth weight

Question 8

What are the causes of hypertension in children?

Answer 8

Renal parenchymal disease, renal vascular disease, coarctation of aorta, endocrine problems, iatrogenic and essential hypertension

Question 9

How should hypertension in children be investigated?

Answer 9

Urine dip, U&Es, creatinine, FBC and examination of pulses

Question 10

How is hypertension in children managed?

Answer 10

Treat cause
Advice in lifestyle modification
If symptomatic medical treatment with ACEi, Beta blockers, thiazide diuretics and calcium blockers

Question 11

How does a paediatric hypertensive crisis present

Answer 11

Cerebral oedema, heart failure, seizures, pulmonary oedema and renal failure.

Question 12

How is a paediatric hypertensive crisis managed?

Answer 12

Treat with nifedipine, labetolol or sodium nitroprusside and reduce BP gradually overall several hours.