Table 1.

Medical checklist for providers managing PWS

Age	Medical Eval	Anticipatory guidance	Medical referrals	Labs	Diagnostic	Medication/supplement considerations
Newborn infants	Feeding Growth & Dev't Tone Gonadal dev'ta	<20 min per feeding Diet has appropriate macro‐ and micronutrients development Early intervention services Sufficient environmental stimulation Support groups	Genetics Endocrine Ophthalmologyb Pulmonary Nutrition OT, PT, ST Neurology, Urology prn	IGF1, IGFBP3 Thyroid studies (free T4 and TSH)d 25‐OH vitamin D	PSG (before starting GH and 8–12 weeks after starting) Echocardiogram if murmur (4% CHD) Hip US (DDH) Feeding eval	Growth hormone* Multivitamin Trial the supplementsc
1 month–1 year	Growth & dev't Gonadal dev't Vision (strabismus) Feeding	Early interventional services Cognitive dev't Routines Limit‐setting Seizures (5%–10%) Support groups	Endocrine Genetics Ophthalmologyb Pulmonary Nutrition ST, OT, PT Audiology Neurology, urology prn	IGF1d, IGFBP3d Thyroid studiesd CBC B12 level prn Adrenal eval 25‐OH vitamin D iron studies	PSG as above Swallow study EEG prn Scoliosis screening X‐ray (when can sit up with core) X‐ray hip (DDH)	Growth hormone* HCG in males with cryptorchidism (3–18 months old); consider orchiopexy Multivitamin Trial the supplementsc
1–5 years old	Growth & dev't Vision Hearing Feeding Scoliosis Sleep Behavior Gastroenterology/nutrition	Dental Care (increased risk of caries) Early intervention Behavior Socialization Access to food and environmental modifications for the family Constipation Slowed metabolism Routine Limit‐setting Support groups DDA	Endocrine Genetics Ophthalmologyb Pulmonary Nutrition ST, OT, PT hippotherapy aquatic, and others Behavioral specialist Dentiste Neurology prn	IGF1d, IGFBP3d Thyroid studiesd Calcium Electrolytes CBC B12 prn Adrenal eval Lipid panel 25‐OH vit D iron studies	PSG prn Swallow evaluation prn EEG prn Scoliosis screening X‐ray NP eval	Growth hormone* HCG in males with cryptorchidism (3–18 months old), consider orchiopexy Trial of supplementsc
5–13 years oldj	Growth & dev't Pubertal dev't (premature adrenarche, precocious puberty) Vision Skin examination (picking) Hearing Feeding Scoliosis Sleep Behavior Gastroenterology/nutrition	Access to food as noted Socialization Routine Limit‐setting Constipation Weight management Behavior OSA Daytime sleepiness High pain tolerance Gastric necrosis Support groups DDA	Endocrine Genetics Ophthalmologyb Pulmonary Nutrition ST, PT, OT hippotherapy aquatic, and others Behavioral specialist Neurology prn Dentiste	Thyroid studies,d IGFI,d IGFBP3d Hemoglobin A1C Fasting insulin and glucose Calcium Electrolytes CBC B12 prn Adrenal eval Lipid panel Pubertal eval as indicated	PSG prn Feeding eval MSLT prn PFTs EEG prn Scoliosis screening X‐ray NP eval	Growth hormone* modafinilg stimulantf N‐acetylcysteine SSRIsh Antipsychotics Metformin supplementsc
13–21 years old	Cardio‐vascular examination (at risk for heart failure) if obese Skin examination (Picking) Pubertal dev't Scoliosis Feeding Exercise Psychosis Behavior Gastroenterology/nutrition	Routine Skin care Behaviors (e.g., psychosis) School placement Gastic necrosis Gynecologic care Constipation Weight management Access to food as noted Sexual/behavioral health Socialization Guardianship Transition of care Support groups DDA	Endocrine Genetics Ophthalmologyb Pulmonary Nutrition ST, PT, OT, hippotherapy aquatic, and others Behavioral specialist Psychiatry prn Neurology prn Dentiste	Thyroid studiesd IGF1,d IGFBP3d Fasting insulin and glucose Hemoglobin A1C Oral glucose tolerance test Calcium CBC Electrolytes B12 prn Lipid panel Adrenal eval Pubertal evalj	PSG prn Feeding eval DEXA MSLT prn EEG prn Pelvic US assess uterine lining Scoliosis screening X‐ray NP eval	Growth hormone modafinilg stimulantf N‐acetylcysteine SSRIsh antipsychotics HRT Metformin GLP−1 receptor agonistsi supplementsc
Adult	Cardio‐vascular examination (at risk for heart failure) Skin exam Weight Psychosis Sleep Behavior Gastroenterology/Nutrition	Routine Skin care Behavior (e.g., psychosis) Risk intestinal necrosis Daytime sleepiness Gynecologic care Socialization Constipation Weight management Guardianship Transition of care Support groups DDA	Endocrine Genetics Ophthalmologyb Pulmonary Nutrition ST, PT, OT, hippotherapy aquatic, and others Behavioral specialist Psychiatry prn Neurology prn Dentiste	Thyroid studiesd IGF1 (at least yearly) Hemoglobin A1C Fasting insulin and glucose Oral glucose tolerance test Calcium Electrolytes CBC B12 prn Lipid Panel Adrenal eval Pubertal evalj	PSG prn Swallow study prn DEXA MSLT prn PFTs EEG prn Pelvic US as above X‐ray to monitor scoliosis	Growth hormone HRT modafinilg stimulantf antipsychotics N‐acetylcysteine SSRIsh Metformin GLP−1 receptor agonistsi supplementsc

AI: adrenal insufficiency; CBC: complete blood count; CHD: congenital heart disease; CoQ10: coenzyme Q10; DDA: developmental disabilities administration; DDH: developmental dysplasia of the hip; dev't: development; DEXA: dual‐energy X‐ray absorptiometry; DHA: docosahexaenoic acid; DHEA‐S: dehydroepiandrosterone sulfate; EEG: electroencephalogram; Eval: evaluation; FSH: follicle stimulation hormone; GGT: glucose tolerance test; GH: growth hormone; GLP‐1: glucagon‐like peptide‐1; HCG: human chorionic gonadotropin; HRT: hormone replacement therapy; IGF1: insulin‐like growth factor 1, somatomedin C; IGFBP3: insulin‐like growth factor‐binding protein 3; LH: luteinizing hormone; MCT: medium‐chain triglycerides; MSLT: multiple sleep latency test; NP: neuropsychological eval; OCD: obsessive–compulsive disease; OSA: obstructive sleep apnea; OT: occupational therapy; PFT: pulmonary function tests; prn: as needed; PSG: polysomnography; PT: physical therapy; PWS: Prader–Willi syndrome; SSRI: selective serotonin reuptake inhibitor; ST: speech therapy; T4: thyroxine; TSH: thyroid stimulation hormone; US: ultrasound.

^*FDA approved treatment.

^aAssess if testes are descended or whether an inguinal hernia is present.

^bAs needed (at risk for strabismus, cataracts and/or nystagmus).

^cTrial of supplements (one at a time) such as CoQ10, Carnitine, MCT oil, DHA, B12 particularly if low levels are detected.

^dAt least once yearly (or if symptomatic for thyroid disease).

^eMore frequent cleaning every 3–4 months.

^fIf child has attention deficit symptoms and/or impulsivity.

^gBased on behavior and sleepiness during the day.

^hFor behavioral concerns, depression, anxiety particularly if severe.

ⁱFor treatment for insulin resistance on case‐by‐case basis.

^jConsider on case‐by‐case basis: Testosterone (total, male), Prolactin, DHEA‐S (adrenarche), FSH/LH (ultrasensitive for precocious puberty), Estradiol (female), anti‐Mullerian hormone, Inhibin B