Weight Loss (In A Page: Pediatric Signs and Symptoms)
Weight Loss
The norm in infants and children is to gain weight, so weight loss in a pediatric patient (unless medically indicated) should demand evaluation. Acute weight loss, defined as loss of 3–5% of body mass in less than 30 days, signals illness and is often the result of the loss of fluid or body mass from catabolism or starvation.
Differential Diagnosis
- Infectious
–The most common cause overall and can be divided into acute and chronic
–Gastroenteritis most common infection
–May be viral, bacterial, fungal, or parasitic
–Estimated 21–37 million episodes a year in
children under 5
–Others include strep, osteomyelitis, EBV, TB
-
Psychiatric/psychosocial
–Anorexia nervosa
–Bulimia
–Depression
–Rumination
–Drugs: Cocaine, amphetamines, laxatives
-
Gastrointestinal disorders
–Gastroesophageal reflux disease
–Inflammatory bowel disease
–Hepatitis
–Pancreatitis
–Pancreatic insufficiency (e.g., CF,
Shwachman syndrome)
–Celiac disease
–Sucrase-isomaltase deficiency
–Fat malabsorption: Abetalipoproteinemia
–Protein malabsorption: Hartnup disease
–Superior mesenteric artery syndrome
-
Nutritional
–Dieting; inadequate caloric intake
–Iron deficiency
–Zinc deficiency
–Neglect
-
Metabolic/endocrine
–Diabetes mellitus
–Diabetes insipidus
–Addison disease
–Hyperthyroidism
–Hypopituitarism
-
Malignancy
-
HIV
-
Acute/chronic renal failure
-
Inflammatory
–Systemic lupus erythematosus
–Juvenile rheumatoid arthritis
–Sarcoidosis
-
Neurologic
–Increased ICP: Pseudotumor cerebri, mass
-
Cardiopulmonary
–Cystic fibrosis
–Congenital heart disease
–Congestive heart failure
Workup and Diagnosis
- History
–Bowel function including number and consistency of stools, melena, hematochezia, vomiting, abdominal pain, fever, headache, diaphoresis, sick contacts, travel history, oral intake
–Diet history: Food consumption, number of meals
–Medications: Prescription and over-the-counter
–Social history: Changes in family structure, alcohol,
illicit drug use, smoking, changes in grades in school, changes in activities and interests
–Developmental history: Milestones, multiple points on growth curve
-
Physical exam
–Height/weight, pulse, blood pressure, mucous membranes, scleral icteris, adenopathy, neck mass, thyroid, lung sounds, murmurs, abdominal mass/tenderness, hepatosplenomegaly, skin turgor, joint tenderness, neuro exam including funduscopy, gynecologic exam
-
Laboratory/radiology are based on H&P
–Initial electrolytes, CBC with differential
–Consider LFT, amylase/lipase, ESR, iron studies
–Throat culture, stool culture, stool for O&P
–Stool for blood, urinalysis and culture, fat/reducing
substances, thyroid function
–HIV test, PPD
–Consider chest X-ray
–Limited value of CT/MRI unless dictated by H&P
Treatment
-
Initial goals are to achieve fluid balance via rehydration and to correct electrolyte disturbances
-
Caloric assessment and possible dietary supplementation
-
Treat infectious causes if medically indicated
-
Psychiatric care
–For eating disorders, depression, drug abuse
-
Malabsorption
–May require special formulas/restriction diets
–May require pancreatic enzymes
-
Treat endocrine disturbance
-
Anti-inflammatory medications for IBD
-
Surgical correction of cardiac anomalies
Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2007 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9
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