Childhood

Childhood obesity is increasing in prevalence world-wide, and is an important predictor of adult obesity. As a consequence, many chronic diseases are now appearing in childhood and adolescence, and will contribute to future morbidity and mortality in adulthood. Over the past 5 decades, while the heights of pre-schoolers and school age children appear to have optimised, their weights and body mass indices (BMI) are still increasing. Childhood obesity is defined as a BMI ≳ 95th percentile for age and sex. The family doctor's approach to childhood obesity is to exclude pathological causes and detect complications of obesity for further treatment. However, the main management principles of childhood obesity encompass adopting healthy lifestyle interventions of age-appropriate diet and exercise recommendations which allow normal height growth to continue. The nutritional goal for obese children is to reduce energy-dense foods and increase nutrient density. Regular exercise encourages long term continuation. Equally important is decreasing time spent in sedentary pursuits and substituting with alternative forms of physical activity. For children, behaviour modification involving the family is essential and implementation requires a multi-disciplinary team. There is no data on long term efficacy and safety of medication for treatment of childhood obesity. There is also no role for bariatric surgery in childhood obesity.

Detection through screening of maternal thyrotoxicosis induced central hypothyroidism in newborns.

Use of a third generation TSH assay enabled extremely low values of TSH to be detected through newborn screening. The use of a supplemental free thyroxine improved testing specificity. The hypothyroidism observed is believed to be secondary to suppression of the hypothalamic-pituitary-thyroid axis by placentally transferred maternal thyroxine.