| Symptom | Potential significance | Additional studies or referral (consider) |
| Delayed development | Genetic syndrome | Referral to pediatric geneticist and/or neurologist |
| Short stature or reduced height velocity | Genetic syndrome | Referral to pediatric geneticist |
| Endocrinologic etiology (eg, Cushing syndrome, hypothyroidism, ROHHADNET syndrome [rapid-onset obesity with hypothalamic dysfunction, hypoventilation, autonomic dysregulation, and neural crest tumor]) | 24-hour urine collection for free cortisol, thyroid function tests; referral to pediatric endocrinologist | |
| Headaches (especially morning) | Pseudotumor cerebri | Referral to pediatric neurologist |
| Nausea/vomiting | ||
| Blurred or decreased vision | ||
| Snoring | Sleep apnea, obesity hypoventilation syndrome Inattentive behaviors may be symptoms of insufficient or disrupted sleep | Polysomnogram (sleep study) and/or referral to a pediatric sleep medicine, pulmonologist, or ENT specialist |
| Daytime sleepiness and/or inattentive behaviors | ||
| Nocturnal enuresis | ||
| Abdominal pain (generalized or right upper quadrant) | Gallbladder disease, cholelithiasis | AST, ALT, abdominal ultrasonography; referral to surgeon |
| Nonalcoholic fatty liver disease | AST, ALT; referral to pediatric gastroenterologist (refer to UpToDate content on nonalcoholic fatty liver disease) | |
| Hip pain, knee pain, limp | Slipped capital femoral epiphysis or Blount disease (tibia vara) | Radiographs; referral to pediatric orthopedist |
| Oligomenorrhea or amenorrhea | Polycystic ovary syndrome | Referral to pediatric endocrinologist or adolescent specialist |
| Prader-Willi syndrome | Referral to pediatric geneticist | |
| Urinary frequency, nocturia, polydipsia, polyuria | Type 2 diabetes | Urinalysis, fasting blood glucose, hemoglobin A1c, glucose tolerance test; referral to pediatric endocrinologist |
| Binge eating or purging | Eating disorder | Referral to specialist in eating disorders |
| Insomnia | Depression | Referral to pediatric psychologist or psychiatrist |
| Anhedonia |
