children s health issues
High Blood Pressure in Children
Diagnosis of High Blood Pressure in Children
Measurement of blood pressure Sometimes tests to identify the cause Because the definition of high blood pressure in children depends on a child's age, sex, and height, there is no one value that is considered high. Consequently, doctors use charts that list the different values for boys and girls by age and height. These charts enable doctors to diagnose high blood pressure and to classify how severe it is. To be sure that high blood pressure is not a temporary condition (such as after consumption ofcaffeine), doctors measure blood pressure at least two times during three separate visits. For the most accurate readings, blood pressure is measured after children sit quietly in a chair for 3 to 5 minutes. Their back should be supported, and ideally their feet should be on the floor. Blood pressure is usually measured with a sphygmomanometer (a soft rubber cuff connected to a rubber bulb that is used to inflate the cuff and a meter that registers the pressure of the cuff). Health care practitioners make sure the cuff fits the child's arm. The cuff is inflated enough to stop blood flow. Then practitioners deflate the cuff and use a stethoscope placed over the artery below the cuff to listen for the first pulse and then for the sound of no blood flowing (when the heart relaxes, between beats). Sometimes, doctors use an instrument called an oscillometer to measure blood pressure rather than using a sphygmomanometer and a stethoscope. The oscillometer records blood pressure automatically and quickly. If there is an abnormality, blood pressure is measured again using a sphygmomanometer and a stethoscope to confirm the measurement. Doctors recommend that blood pressure measurements start when children are 3 years old. If young children have risk factors that increase their risk of high blood pressure (such as having a kidney or heart disorder, or having been Preterm (Premature) Newborns ), doctors start measuring blood pressure as early as possible and at each is diagnosed, doctors recheck blood pressure within 6 months. If blood pressure is still high, lifestyle changes, such as an improved diet, more physical activity, and weight loss (if needed), are started. If blood pressure remains high over the next 6 months, children may be given an Ambulatory (home) blood pressure monitoring , if possible, or could be referred to a specialist. An ambulatory blood pressure monitor is a portable battery-operated device, connected to a blood pressure cuff, worn on the arm. This monitor repeatedly records blood pressure throughout the day and night over a 24-hour period. The readings help doctors determine whether high blood pressure is present, how often elevated readings occur, and how severe they are. Ifstage 1 hypertensionis diagnosed, doctors recheck blood pressure within 1 to 2 weeks. If blood pressure remains at stage 1, pressure measurements are taken in an arm and in a leg to see whether there is a difference between them, a urinalysis is done, and lifestyle changes are recommended. Doctors recheck blood pressure in 2 to 3 months, and, if it is still at stage 1, the child should be referred to a specialist. Ifstage 2 hypertensionis diagnosed or children have stage 1 hypertension and symptoms, children are referred immediately to an emergency department or to a specialist for possible hospitalization. Several instruments can measure blood pressure quickly and with little discomfort. A sphygmomanometer is commonly used. It consists of a soft rubber cuff connected to a rubber bulb that is used to inflate the cuff and a meter that registers the pressure of the cuff. The meter may be a dial or a glass column filled with mercury. Blood pressure is measured in millimeters of mercury (mm Hg) because the first instrument used to measure it was a mercury column. When a sphygmomanometer is used, a person sits with legs uncrossed and back supported. An arm is bared (if a sleeve is rolled up, caution is needed to ensure that it is not tight around the arm), bent, and resting on a table, so that the arm is about the same level as the heart. The cuff is wrapped around the arm. Using a cuff that is proportional to the size of the arm is important. If the cuff is too small, the blood pressure reading will be too high. If the cuff is too large, the reading will be too low. Listening with a stethoscope placed over the artery below the cuff, a health care practitioner inflates the cuff by squeezing the bulb until the cuff compresses the artery tightly enough to temporarily stop blood flow, usually to a pressure that is about 30 mm Hg higher than the person's usual systolic pressure (the pressure exerted when the heart beats). Then the cuff is gradually deflated. The pressure at which the practitioner first hears a pulse in the artery is the systolic pressure. The cuff continues to be deflated, and at some point, the sound of blood flowing stops. The pressure at this point is the diastolic pressure (the pressure exerted when the heart relaxes, between beats). Instruments to measure blood pressure are available for home use by people who have high blood pressure. Doctors also take a Medical History , which includes questions about the child's current symptoms, diet (including, salt intake, calorie intake in overweight children, consumption of A thorough Physical Examination and standard blood and urine tests are done. Tests to evaluate kidney function and to check for high cholesterol are also done. Other tests may be done to check for specific disorders based on information from the history and physical examination. 