I just read the CME/CE article by Marilou Shreve, DNP, APRN, entitled, “Assessing and treating pediatric obesity” [June 2015]. I was concerned regarding the oversight of a critical issue in obese adolescents: the increased risk of slipped capital femoral epiphysis (SCFE). This was not addressed in the article.

The case study (p. 55) gave incomplete advice regarding the evaluation of an obese adolescent male with knee pain. The most common etiology of the insidious onset of knee pain in children is the hip, due to referred pain from the obturator nerve. SCFE is the most common hip problem in adolescents, is more common in males than in females, and is seen in much higher incidences related to obesity.

In the obese adolescent, knee pain is a SCFE until proven otherwise. Physical examination, anteroposterior and frog leg pelvis radiographs, and immediate referral to a pediatric orthopedist are critical. Recommending a podiatry referral is not reflective of best practices/standards of care and could result in delayed treatment of a serious medical problem and less than optimal outcome. — SARAH GUTKNECHT, DNP, APRN, CPNP-AC/PC, St. Paul, Minn. (202-4)

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