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Measurement of blood pressure in children. Recommendations of a working party of the British Hypertension Society.

Measurement techniques The only technique that is practicable for widespread clinical application is conventional sphygmomanometry with a well maintained mercury sphygmomanometer. Measurement of systolic blood pressure is preferred to diastolic blood pressure because of its greater accuracy and consistency. The choice of the correct cuff is crucial. To cover the age range 0-14 years a minimum of three cuffs is necessary; recommended bladder sizes are 4 x 13 cm, 8 x 18 cm, and 12 x 35 cm (adult cuff). The widest cuff that can be applied to the arm should be used. The length of the inflation bladder should be at least two thirds of the circumference of the arm and preferably longer. Secure fastening is essential; this may not be possible with Velcro, especially when using the smaller cuffs. In some healthy children aged under 5 years and all children aged under 1 year measurement of blood pressure by conventional sphygmomanometry is impossible because the Korotkoff sounds cannot be heard reliably. In these children and children who are in shock or who have low cardiac outputs more sensitive detection systems such as Doppler ultrasound or oscillometry should be used.