From pediatric-obesity-toolkit
Screen a child with obesity for red flags suggesting monogenic, syndromic, or secondary endocrine causes — distinguishing atypical from typical exogenous obesity. Trigger when a clinician asks whether obesity could be genetic or hormonal, suspects Prader-Willi syndrome, Cushing disease, hypothyroidism, ROHHAD, Bardet-Biedl syndrome, leptin deficiency, or craniopharyngioma, or when a child has early-onset severe obesity, short stature with obesity, hyperphagia, hypotonia, dysmorphic features, or developmental delay with weight gain.
How this skill is triggered — by the user, by Claude, or both
Slash command
/pediatric-obesity-toolkit:pediatric-obesity-etiology-screenerThe summary Claude sees in its skill listing — used to decide when to auto-load this skill
Distinguish typical exogenous obesity from monogenic, syndromic, or secondary endocrine causes using a structured red flag screen.
Distinguish typical exogenous obesity from monogenic, syndromic, or secondary endocrine causes using a structured red flag screen.
Typical exogenous obesity looks like this — if ALL present, atypical cause is less likely:
| Feature | Typical Exogenous Obesity |
|---|---|
| Onset | Gradual, often after age 5 |
| Height | Normal to tall for age (advanced skeletal maturation) |
| Development | Normal milestones |
| Appetite | Increased but not insatiable |
| Dysmorphic features | Absent |
| Family history | Usually positive for obesity |
⚠️ If any feature deviates from the above, proceed through the red flag screen below.
Work through each domain. One or more flags = investigate further.
| Red Flag | Suspect |
|---|---|
| Obesity onset before age 2–5 years, especially severe | Monogenic obesity: leptin deficiency, leptin receptor deficiency, POMC deficiency, MC4R mutation |
| Abrupt, rapid weight gain at any age | Hypothalamic lesion (craniopharyngioma), ROHHAD/ROHHADNET syndrome, new-onset endocrine disorder |
| Red Flag | Suspect |
|---|---|
| Short stature in a child with obesity | Endocrine cause (Cushing disease, hypothyroidism, GH deficiency) or genetic syndrome |
| Declining height velocity despite obesity | Endocrine disorder — especially Cushing or hypothyroidism |
📏 Key rule: Exogenous obesity accelerates growth. A child with obesity who is short or growing slowly almost certainly has a non-exogenous cause. This is one of the most important red flags in paediatric practice.
| Red Flag | Suspect |
|---|---|
| Marked, uncontrollable hyperphagia — insatiable hunger, food-seeking behaviour, food obsession | Monogenic obesity (leptin deficiency, POMC deficiency, MC4R), Prader-Willi syndrome, hypothalamic obesity |
| Red Flag | Suspect |
|---|---|
| Developmental delay or intellectual disability | Syndromic causes: Prader-Willi, Bardet-Biedl, Cohen syndrome |
| Hypotonia in infancy followed by hyperphagia and rapid weight gain in early childhood | Prader-Willi syndrome (classic presentation) |
| Headaches, nausea, vision changes, nystagmus | Craniopharyngioma or other hypothalamic-pituitary tumour |
| Autonomic dysregulation, hypoventilation | ROHHAD/ROHHADNET syndrome |
| Red Flag | Suspect |
|---|---|
| Dysmorphic features — unusual facies, small hands/feet, polydactyly | Bardet-Biedl syndrome (polydactyly), Prader-Willi syndrome, other chromosomal syndromes |
| Delayed or absent puberty, undescended testes, micropenis, small testes | Prader-Willi syndrome, Bardet-Biedl syndrome, leptin deficiency, endocrine cause |
| Precocious puberty | CNS lesion, ROHHAD syndrome |
| Pale skin with red hair (in White individuals) | POMC deficiency (classic triad: early-onset obesity + red hair + adrenal insufficiency) |
| Retinal pigmentation, visual impairment, or deafness | Bardet-Biedl syndrome, Alström syndrome |
| Dry/coarse hair, constipation, cold intolerance, bradycardia | Hypothyroidism |
| Violaceous striae, interscapular fat pad (buffalo hump), moon facies, proximal myopathy, hypertension | Cushing syndrome / Cushing disease |
| Polydipsia, polyuria | Diabetes insipidus (hypothalamic cause), or new-onset T1DM masking with insulin-driven weight gain |
| Flags Present | Most Likely Cause | Urgency |
|---|---|---|
| Onset < 2 yrs + severe hyperphagia, no dysmorphia | Monogenic obesity (leptin, POMC, MC4R) | Elective referral to paediatric endocrinology/genetics |
| Neonatal hypotonia + later hyperphagia + developmental delay + hypogonadism + small hands/feet | Prader-Willi syndrome | Genetic testing (methylation studies) — confirm urgently |
| Polydactyly + retinal dystrophy + intellectual disability + hypogonadism | Bardet-Biedl syndrome | Genetics + ophthalmology referral |
| Short stature + obesity + violaceous striae + buffalo hump | Cushing syndrome | Endocrine workup (24h UFC, midnight salivary cortisol, low-dose DST) |
| Short stature + obesity + dry skin + constipation + bradycardia | Hypothyroidism | TSH + Free T4 — urgent |
| GH deficiency signs + short stature + obesity | GH deficiency | IGF-1, IGFBP-3, GH stimulation testing |
| Rapid-onset obesity + autonomic dysfunction + hypoventilation | ROHHAD/ROHHADNET | Urgent paediatric neurology/respirology |
| Headaches + visual changes + rapid weight gain | Craniopharyngioma | Urgent MRI brain/pituitary |
| Red hair + early-onset obesity + adrenal insufficiency signs | POMC deficiency | Urgent cortisol, ACTH, genetics |
| Visual impairment + sensorineural deafness + obesity | Alström syndrome | Genetics + ophthalmology |
Based on red flags identified, order as indicated:
Endocrine screen (if short stature, striae, or growth deceleration):
Genetic/syndromic workup:
Neuroimaging:
Ophthalmology:
Clinical content synthesised from:
npx claudepluginhub dromlakhani/md2skill --plugin pediatric-obesity-toolkitProvides UI/UX resources: 50+ styles, color palettes, font pairings, guidelines, charts for web/mobile across React, Next.js, Vue, Svelte, Tailwind, React Native, Flutter. Aids planning, building, reviewing interfaces.
Fetches up-to-date documentation from Context7 for libraries and frameworks like React, Next.js, Prisma. Use for setup questions, API references, and code examples.