Weight Loss

Weight Loss: Excerpt from In A Page: Pediatric Signs and Symptoms

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

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

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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