What tests should be run for a 10-year-old who is overweight according to American Academy of Pediatrics (AAP) guidelines?

Recommended Tests for Overweight 10-Year-Old Children According to AAP Guidelines

For a 10-year-old child who is overweight (BMI ≥85th percentile) or obese (BMI ≥95th percentile), the American Academy of Pediatrics recommends a comprehensive laboratory assessment including blood pressure measurement, fasting lipid panel, liver function tests, and glucose testing to screen for obesity-related complications.

Initial Assessment

• BMI calculation and plotting on age-appropriate growth charts to confirm overweight (85th-94th percentile) or obesity (≥95th percentile) 1
• Blood pressure measurement (three separate readings) - abnormal if BP >95th percentile for age, height, and sex 2
• Complete physical examination with specific attention to:
  • Acanthosis nigricans (associated with insulin resistance/type 2 diabetes) 2
  • Hepatomegaly (associated with non-alcoholic fatty liver disease) 2
  • Hip or knee pain (may indicate slipped capital femoral epiphysis) 2
  • Leg bowing (may indicate Blount's disease) 2
  • Sleep-related symptoms (snoring, breathing difficulties, daytime somnolence) 2

Laboratory Testing

Cardiovascular/Metabolic Assessment

• Fasting lipid panel 2, 1

  • Abnormal values: total cholesterol >170 mg/dL, LDL >110 mg/dL, triglycerides >100 mg/dL, HDL <45 mg/dL

• Fasting glucose and insulin determination 2

  • Abnormal glucose: diabetes ≥126 mg/dL, impaired fasting glucose 100-125 mg/dL
  • Consider 2-hour oral glucose tolerance test if risk factors present

• Liver function tests (ALT and AST) 2, 1

  • Abnormal values: >22 U/L for girls and >26 U/L for boys

Additional Testing Based on Risk Factors

• Sleep study if symptoms of obstructive sleep apnea present 2
• Thyroid function tests if clinical suspicion of hypothyroidism 2
• Further orthopedic evaluation if symptoms of musculoskeletal complications present 2

Psychological Assessment

• Screening for depression, bullying, and psychological distress 2
• Assessment for disordered eating behaviors 2
• Evaluation of family dynamics and social support 2

Follow-up Recommendations

• If initial tests are normal but the child remains overweight, repeat testing at minimum 3-year intervals 2
• More frequent testing if BMI is increasing 2
• Annual comprehensive foot exam once the child has had type 1 diabetes for 5 years 2

Common Pitfalls to Avoid

1. Focusing only on weight rather than comprehensive health assessment - Remember that obesity-related complications can occur even in the absence of severe obesity 3

2. Neglecting psychological impact - Weight teasing and inappropriate weight talk can lead to disordered eating behaviors and psychological distress 2

3. Missing family history significance - Family history of dyslipidemia correlates with child's lipid disturbances, and family history of ischemic events or T2DM correlates with cardiovascular risk factors in the child 3

4. Overlooking non-medical complications - Issues related to well-being such as bullying, psychological complaints, and abnormal sleeping patterns are extremely common (79.4%) in overweight children 3

The early identification of obesity-related complications through appropriate screening allows for timely intervention and may prevent progression to more serious health problems in adulthood.