Evaluation of weight loss in infants over six months of age, children, and adolescents
- Derya Caglar, MD
Derya Caglar, MD
- Assistant Professor
- University of Washington School of Medicine/Seattle Children’s Hospital
- Section Editor
- George A Woodward, MD
George A Woodward, MD
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics
- University of Washington School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic will discuss the approach to weight loss in the older infant and adolescent. Weight loss in young infants is discussed separately. (See "Evaluation of weight loss in infants six months of age and younger".)
There are many causes of weight loss throughout childhood. Dehydration, infection (especially viral gastroenteritis), malnutrition, and child neglect are common causes in older infants and young children. Depression, eating disorders, inflammatory bowel disease, malignancy, and malabsorption (eg, lactose intolerance, celiac disease) are more frequent in school-age children and adolescents. Weight loss and slow weight gain can have serious long term consequences extending into adulthood . Assessments of the degree and acuity of the weight loss along with specific historical and physical findings should guide the evaluation of these patients.
Weight loss may be classified as intentional or unintentional:
●Acute or progressive unintentional weight loss often indicates a serious medical illness that requires evaluation and treatment.
●Intentional weight loss in overweight or obese individuals is benign in most instances but must be followed closely in the pediatric patient to insure the patient has appropriate growth. The frequency of intentional loss in association with altered body image or other psychiatric illness (eg, anorexia nervosa) increases with advancing age, peaking in adolescence and early adulthood.
- Hoddinott J, Behrman JR, Maluccio JA, et al. Adult consequences of growth failure in early childhood. Am J Clin Nutr 2013; 98:1170.
- Tunnessen WW, Roberts KB. Weight loss. In: Signs and Symptoms in Pediatrics, 3rd edition, Lippincott, Williams & Wilkins, Philadelphia 1999. p.36.
- Block RW, Krebs NF, American Academy of Pediatrics Committee on Child Abuse and Neglect, American Academy of Pediatrics Committee on Nutrition. Failure to thrive as a manifestation of child neglect. Pediatrics 2005; 116:1234.
- Ficicioglu C, An Haack K. Failure to thrive: when to suspect inborn errors of metabolism. Pediatrics 2009; 124:972.
- Kirkpatrick SI, McIntyre L, Potestio ML. Child hunger and long-term adverse consequences for health. Arch Pediatr Adolesc Med 2010; 164:754.
- Geskey JM, Erdman HJ, Bramley HP, et al. Superior mesenteric artery syndrome in intellectually disabled children. Pediatr Emerg Care 2012; 28:351.
- Gerasimidis T, George F. Superior mesenteric artery syndrome. Wilkie syndrome. Dig Surg 2009; 26:213.
- Benjamin RW, Moats-Staats BM, Calikoglu's A, et al. Hypercalcemia in children. Pediatr Endocrinol Rev 2008; 5:778.
- DIFFERENTIAL DIAGNOSIS
- Life threatening conditions
- - Diabetes mellitus
- - Adrenal insufficiency
- - Eating disorders
- - Dehydration
- Common conditions
- - Viral gastroenteritis
- - Depression
- - Inflammatory bowel disease
- - Acute infections
- - Celiac disease
- - Child neglect
- - Malnutrition and failure to thrive
- - Lactose intolerance
- - Drug use
- Other conditions
- Physical examination
- Ancillary studies
- Acute weight loss
- Chronic weight loss
- SUMMARY AND RECOMMENDATIONS