A 4-year-old girl presents to the pediatrician for her annual physical examination. Her height for age is at 55th percentile and her weight for age is at the 95th percentile. All of her vaccinations are current. She is enrolled in preschool three days per week, and greatly enjoys time spent with classmates. She is able to hop on one foot without losing her balance and can throw a ball overhand in a coordinated fashion. She remains unable to tie her shoelaces and continues to wear pull-up diapers at night because she occasionally urinates while asleep. Her sentences are typically four to six words long and she can count to five. She frequently discusses her imaginary playmates and enjoys singing simple songs. Which of the following is the most likely explanation for her condition?

Question

A 4-year-old girl presents to the pediatrician for her annual physical examination.  Her height for age is at 55th percentile and her weight for age is at the 95th percentile.  All of her vaccinations are current.  She is enrolled in preschool three days per week, and greatly enjoys time spent with classmates.  She is able to hop on one foot without losing her balance and can throw a ball overhand in a coordinated fashion.  She remains unable to tie her shoelaces and continues to wear pull-up diapers at night because she occasionally urinates while asleep.  Her sentences are typically four to six words long and she can count to five.  She frequently discusses her imaginary playmates and enjoys singing simple songs.  Which of the following is the most likely explanation for her condition?

Quizplus · Accepted Answer

Explanation: Increasingly common in children today, obesity most often results from an imbalance of caloric intake and energy expenditure. This child is meeting the expected developmental milestones for her age and there is no suggestion of physical abnormalities. Therefore, the most likely cause of her obesity is overeating. (Choice A)Cushing syndrome is an endocrinologic cause of obesity and is typically associated with findings such as moon facies, supraclavicular fat pads, buffalo hump, truncal obesity, and striae. There is no evidence that this girl is suffering from Cushing syndrome. (Choice C)Major depression is diagnosed when at least five of nine depressive symptoms are present for at least two weeks. Atypical depression is associated with hypersomnia and hyperphagia. However, there is no mention of abnormal mood symptoms in this child, which makes depression a very unlikely diagnosis. (Choice D)Hypothyroidism is an endocrinologic cause of obesity and is typically associated with findings such as coarse facial features, slow movements and speech, hoarseness, macroglossia, goiter, dry skin, brittle hair, or edema of the extremities. There is no evidence that this girl is suffering from hypothyroidism. (Choice E)Although type 2 diabetes mellitus is linked with obesity and is increasingly found in older children and adolescents, it still accounts for only 20% of all cases of diabetes mellitus in this patient population. In this scenario, there is no clinical evidence that the girl suffers from either form of diabetes mellitus. Educational Objective: Focus on the common causes of common medical conditions. Obesity in children and adults most often results from overeating, and not from endocrinologic disorders like hypothyroidism or Cushing disease.

A 4-Year-Old Girl Presents to the Pediatrician for Her Annual