Table.2.

Suggested questions addressing neuromusculoskeletal complications related to pediatric obesity

No	Question to parent and/or their child	Why ask?	What next?
1	Does your child/adolescent report any pain or discomfort in their feet, legs, back, arms, neck, or anywhere else?	Children with obesity experience more pain, particularly in the lower extremity which may influence engagement in active play/sport.	If present, thorough pain profiling and objective musculoskeletal assessment and treatment by a suitably qualified pediatric HCP is indicated.
2	Does your child/adolescent fatigue (get tired) easily when playing games/activities compared to others their age?	Children with obesity can experience greater muscle fatigue and perceived exertion especially in weight-bearing activity which can affect their ability or interest in playing actively with peers.	If present, objective musculoskeletal assessment, and sleep screening indicated. Treatment by a suitably qualified pediatric HCP is indicated.
3	Does your child/adolescent have difficulties staying balanced when moving/playing or do they fall more often compared to others their age?	Children with obesity can have more impaired balance and are more at risk of falling.	If present, objective assessment and treatment by a suitably qualified pediatric HCP is indicated.
4	Does your child/adolescent experience any physical difficulties with everyday childhood tasks (e.g., walking, running, jumping, hopping, ball skills, physical play, dressing, toileting, showering, picking something up from the floor)?	Children with obesity can have more impaired functional capacity and fundamental motor skills which can affect their ability or interest in playing actively with peers.	If present, objective assessment and treatment by a suitably qualified pediatric HCP is indicated.
5	Does your child/adolescent experience any physical difficulties with participating within the community (e.g. PE, cycling to school)?	Children with obesity can have more impaired coordination and fundamental motor skills which can affect their ability to engage in organized activities with their peers. Children with obesity may experience isolation due to physical impairments or increased risk of teasing by peers.	If present, objective assessment and treatment by a suitably qualified pediatric HCP is indicated.
6	Does your child/adolescent experience any other difficulties when moving, or playing (e.g., breathing difficulties, headaches, urinary incontinence, teasing/bullying)?	Children with obesity can have more impaired respiratory function, higher blood pressure, and greater risk of incontinence and bullying which can affect their functional capacity or interest in playing with peers.	If present, objective assessment and treatment by a suitably qualified pediatric HCP is indicated.
8	In the last week, how many days was your child engaged in moderate or vigorous physical activity for at least 60 min/day (‘huff and puff’ activity)?	Children with obesity can have lower levels of MVPA compared to lean peers. Understanding why a child is not participating in the recommended level is key to addressing these barriers through progressive physical activity intervention. Lower MVPA levels may be due to greater fatigue, more physical impairments, and challenges participating in suitable fun and rewarding activities.	If not meeting recommended age-appropriate guideline for MVPA, explore if there are barriers and commence goal setting and problem solving to address these.
9	Is there anything about your child’s physical movement or activity that you/they are concerned about or would like to improve?	Additional factors including preferences, goals, financial difficulty, safety, low confidence, lack of comfortable clothes/shoes that fit, inability to fit in shower at home/school, or negative body image may need to be considered and integrated into treatment planning.	If parent or child express concern, determine whether these can be addressed by you or whether onward referral may be required.

HCP healthcare professional, MVPA moderate to vigorous physical activity