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 — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
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.
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".)
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.
The major components of body weight consist of water, protein, carbohydrates, and fats. Weight loss occurs when the intake of one or several of these components becomes less than the output. Causes include:
●Decreased calorie intake either voluntary (eg, eating disorder) or due to intercurrent illness with normal or increased metabolic expenditure
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- 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