Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
!
Acute metabolic or cardiorespiratory complication
Diabetic ketoacidosis, hyperosmolar illness, hypertensive emergency, severe obstructive sleep apnoea with cardiorespiratory compromise or acute eating-disorder instability requires emergency care, irrespective of body size.
Action: Assess airway, breathing, circulation, glucose, ketones, neurological state and blood pressure using age-appropriate ranges. Follow emergency paediatric pathways and obtain specialist input. Do not attribute breathlessness, abdominal pain or collapse to weight without excluding acute disease.
Synopsis
Measure adiposity accurately, discuss it with permission and without stigma, identify severe early-onset or secondary causes and complications, and offer family-centred multicomponent support that addresses food, activity, sleep, mental health and structural barriers.
Ask permission to discuss growth, use person-first language and explain that health is influenced by biology, medicines, environment and resources. Do not blame the child or family.
Measure height and weight accurately and plot BMI centile for age and sex on an appropriate UK chart; adult BMI cut-offs must not be applied to children.
NICE uses the 91st centile for overweight, 98th for clinical obesity and 99.6th for severe obesity when assessing an individual child.
Key red flags
Polyuria, polydipsia, weight loss, vomiting, abdominal pain or deep breathing requires same-day glucose and ketone assessment for diabetes.
Investigation priorities
01
First-line: BMI centile and growth trajectoryFirst stepFirst line
Confirm weight status and detect disproportionate linear growth.
Management branches
DiscussAsk permission and plot
Growth measurements indicate a high BMI centile.
Confirm height and weight and show the age- and sex-specific trajectory neutrally.
Ask permission to discuss health, preferred words and the child's priorities.
First lineOffer family-centred multicomponent support
The family is ready to work on one or more health behaviours.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.