Safety Considerations for Hospitalized Children and Adolescents With Obesity

Children and adolescents with obesity make up a growing proportion of hospitalized patients. As a result, pediatric hospital providers are increasingly providing care for patients whose weight meaningfully influences safety during admissions. This review provides practical, evidence-informed guidance for the inpatient care of children and adolescents with obesity to prevent harm and optimize healing. Key safety considerations include identifying obesity-related complications and obesity medications that can impact inpatient risk, using tailored laboratory and imaging strategies that account for body habitus, appropriate medication dosing scalars to mitigate risk for toxicity and/or treatment failure, and recognizing heightened risks during sedation. We also discuss increased risk of venous thromboembolism, ensuring appropriately sized hospital equipment, guidance for nonstigmatizing communication, and safety of hospital staff when moving, lifting, or assisting patients. For patients with prior bariatric surgery, we outline early complications, altered pharmacokinetics, approach to nutrition support, and assessment of micronutrient deficiencies, which can occur rapidly. By centering safety, this review equips hospital-based clinicians to deliver individualized, equitable, and effective care to children and adolescents with obesity. Recognizing obesity comorbidities, partnering across interdisciplinary teams, and minimizing weight stigma can improve clinical outcomes and the patient experience for hospitalized children and adolescents with obesity.