Information

  • Undertaken to screen high risk children for preventable chronic conditions and to provide early intensive Lifestyle modifications particularly among Aboriginal and Torres Strait Islander children who are at greatest risk

Health check recommendations

  • All children > 10 years with a BMI > 85th percentile for age and gender (See Overweight and obesity (child)) for:
    • pre-diabetes
    • diabetes mellitus
    • dyslipidaemia
    • pre-hypertension and hypertension
    • Non-alcoholic Fatty Liver Disease (NAFLD)
    • Polycystic Ovary Syndrome (PCOS)
    • Obstructive Sleep Apnoea (OSA)
    • social-emotional wellbeing

1. Procedure

  • Undertake assessments as below
  • Provide brief intervention and resources
  • These children require a referral and close follow-up and monitoring. Place on a recall register
    1. Blood pressure 4
      • Measured (Resource 1.):
        • using a manual or automatic sphygmomanometer. Check that automatic unit is set to paediatric
        • to the nearest 2 mmHg
        • initially on both arms
        • using the arm with the higher reading for all subsequent measurements
        • while sitting and after standing for 2 minutes, if postural hypotension (low BP while standing, sitting or lying) is suspected
    2. Pathology
      • Undertaken by a suitably qualified clinician according to local policies and guidelines. See Resource 2.
      • Take pathology according to Table 1.
    3. Obstructive Sleep Apnoea (OSA) 2–4,7
      • Ask and document whether the child snores or stops breathing while sleeping
      • Assess a patient’s daytime sleepiness and OSA risk by using a validated tool. If they score highly refer to a sleep specialist. See Resource 3.
    4. Social-emotional wellbeing
      • Assess the child’s social-emotional wellbeing by open discussion. See Social-emotional wellbeing (child)

2. Results

  • See Table 1. for pathology values

Table 1. Venous blood results 1,2,7–10

Assessment

Diagnostic targets

Pre-diabetes

  • HbA1c: 5.7% to < 6.5% (39 to < 48 mmol/mol)
  • Fasting blood glucose: ≥ 5.6 to < 7.0 mmol/L
  • Oral Glucose Tolerant Test (OGTT): 2 hour result ≥ 7.8 to < 11.1 mmol/L

Diabetes

  • HbA1c: ≥ 6.5% (≥ 48 mmol/mol)
  • Fasting blood glucose: ≥ 7.0 mmol/L
  • Oral Glucose Tolerant Test (OGTT): 2 hour result ≥ 11.1 mmol/L
  • A child with classic hyperglycemia symptoms: RBG ≥ 11.1 mmol/L

Venous lipids (mmol/L)

Rating

Total-C

TG

LDL-C

HDL-C

Acceptable

< 4.4

< 1.02

2.85

> 1.17

Borderline high

4.4–5.15

1.02–1.46

2.85–3.34

1.04–1.17

High

≥ 5.15

≥ 1.46

≥ 3.34

≤ 1.04

NAFLD

ALT > 25 U/L (boys)

ALT > 22 U/L (girls)

  1. Blood pressure 3–6
    • Normal range for systolic BP levels are:
      • 90–110 for children aged 8–12 years
      • 100–120 for children aged > 12 years
    • Values higher than these indicates Hypertension and requires referral
  2. Polycystic Ovary Syndrome (PCOS) 2,3,11–13
    • The diagnosis of PCOS in an adolescent girl is made based on:
      • > 35 days between menstruating on a regular basis (oligomenorrhea) and
      • the presence of clinical evidence of hyperandrogenism:
        • excessive male pattern terminal hair or
        • acne or
        • male pattern baldness or hair thinning (androgenic alopecia) and/or
      • biochemical evidence in consultation with MO/NP e.g. luteinising hormone (LH), follicle-stimulating hormone (FSH), oestradiol, thyroid function tests (TFT) etc.
  3. Obstructive Sleep Apnoea (OSA) 2–4,7
    • Children 5–13 years old should have 9–11 hours of uninterrupted sleep per night
    • Teenagers 14–17 years old should have 8–10 hours of uninterrupted sleep per night
  4. Social-emotional wellbeing 2,3,7,11–13
    • All children exposed to the possibility of having or developing a chronic condition should undergo a Social-emotional wellbeing assessment

3. Brief intervention 1–7,8,11–13

  • Brief intervention relies on intensively addressing lifestyle behaviours to:
    • maintain or improve Diet and nutrition
    • reduce Overweight and obesity (child)
    • increase Physical activity and sleep
  • Engaging our patients is essential for effective outcomes
    1. Hypertension 3–6
      • Measured to detect primary hypertension and asymptomatic hypertension secondary to underlying disorders e.g. coarctation of the aorta, environmental exposures, medications
      • Hypertension in children increases the risk for persistent hypertension in adulthood, metabolic syndrome and accelerated vascular aging
    2. Prediabetes and diabetes 1
      • Measured to identify diabetes, characterised by high blood glucose levels (BGL) and disturbance of carbohydrate, fat and protein metabolism
      • Diabetes destroys small blood vessels, and reduces the ability of nerves to function (diabetic neuropathy) leading to many problems including blindness and limb amputations
    3. Dyslipidaemia 2–7,13
      • Performed to measure circulating blood lipids (fats). See Dyslipidaemia
      • Causes blood vessel wall narrowing and blockages leading to Coronary heart disease and Stroke and transient ischaemic attack
      • Pharmacological treatment should be considered for children aged > 10 years, who are overweight or obese with an LDL-C of:
        • < 4.9 mmol/L or
        • < 4.1 mmol/L with a family history of early heart disease or 2 additional risk factors present or
        • > 3.4 mmol/L if diabetes mellitus is present
    4. Non-alcoholic Fatty Liver Disease (NAFLD) 2,3,9,10
      • Affects 25–45% of people
      • NAFLD risk increases with BMI
      • Associated with impaired glucose tolerance, insulin resistance, central obesity, dyslipidaemia and hypertension; all risk factors for cardiovascular disease
      • Also associated with liver inflammation and fibrosis, cirrhosis and cancer
    5. Polycystic Ovary Syndrome (PCOS) 2,3,11–12
      • A hormonal condition where many partially formed follicles occur on the ovaries resulting in:
        • menstrual irregularity
        • high levels of male hormone (hyperandrogenism)
        • obesity and insulin resistance with a tendency to develop type 2 diabetes
        • low fertility
      • Overweight and obesity (child) is the biggest risk factor for PCOS. Lifestyle modifications for weight loss is usually the first therapeutic intervention
    6. Obstructive Sleep Apnoea (OSA) 2–4,7
      • OSA is higher among obese children and is associated with upper and lower airway inflammation, anxiety, depression and many other chronic conditions
      • See Physical activity and sleep
    7. Social-emotional wellbeing
      • See Social-emotional wellbeing (child)

4. Referral

  • Refer all abnormal results of above assessments to the MO/NP for further investigations and an action plan
  • All referrals will rely on intensive Lifestyle modifications interventions

5. Follow-up

  • Monitor closely. Place these children on a recall register
  • Ensure all referrals are actioned
  • Provide the child or parent with the next scheduled follow-up appointment

6. References

7. Resources

  1. Cardiac Auscultation Reference Guide for taking blood pressure
  2. Queensland Health Pathology Specimen collection policies and guidelines
  3. The Epworth Sleepiness Scale and STOP-Bang questionnaire

Last updated: September 2024

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