If you’re the parent of a young child, it’s likely you’ve asked at a recent medical checkup about how your child’s height and weight compared with peers. Measuring how kids are growing is not only something that’s done to satisfy parents’ curiosity, it also helps in determining if a child is growing properly, is putting on too much weight or, conversely, isn’t gaining enough.
But there’s another measurement experts say parents should be asking their child’s doctor about as well — one that you may not think to check on: blood pressure. “How’s my child’s blood pressure doing?” is a question Dr. David Kaelber, who has researched the under-diagnosis of pediatric hypertension, encourages parents to tag onto the discussion. Kaelber is the co-chair of the American Academy of Pediatrics Subcommittee on Screening and Management of High Blood Pressure in Children, which recently developed the new clinical practice guidelines for screening and managing high blood pressure in kids.
The fresh guidance — which was endorsed by the American Heart Association — is aimed at clinicians, but experts say there are some takeaways worth noting for parents. Chief among those: Parents are urged to be proactive in making sure a child is not only screened regularly for high blood pressure, but that those results are interpreted in accordance with the new guidelines.
[See: 10 Concerns Parents Have About Their Kids’ Health.]
Unlike adults, where what’s considered a healthy or normal blood pressure is the same for all, in kids the numbers vary. “There’s not one blood pressure level for children that’s considered abnormal,” says Dr. Marva Moxey-Mims, chief of the division of nephrology at Children’s National Health System in the District of Columbia. “So what’s considered normal varies by the age of the child, the sex of child and the height of the child.”
The new guidelines slightly change what’s considered normal blood pressure for kids. “Under the 2004 guidelines a blood pressure needing further evaluation for the 7-year-old boy would be 107/71,” explains Kaelber, a professor of internal medicine, pediatrics and population and quantitative health sciences at Case Western Reserve University and staff physician and chief medical informatics officer in the MetroHealth System in Cleveland. The first or upper number in a blood pressure reading — or systolic blood pressure — indicates how much pressure is put on the artery walls when the heart beats; the lower number, or diastolic blood pressure, is a measurement of that pressure when the heart is resting. “Under the 2017 guidelines, a blood pressure needing further evaluation for the 7-year-old boy would be 106/68,” Kaelber says. “In the 2017 guidelines, stage 2 hypertension for the 7-year-old boy of average height would be 124/85. Typical blood pressure for this 7-year-old boy of average height would be 97/58.”
The change accounts for the fact that previous blood pressure level guidelines were based, in part, on data from kids who were overweight. “We know that children that have weight problems are more likely to have blood pressure problems,” Kaelber says. New lower blood pressure guidelines are based on looking at blood pressure in kids of normal, healthy weight. “The net effect of this is that there will be a slightly larger group of children that will be identified as having an abnormal blood pressure that needs further monitoring and evaluation,” he says.
Starting at age 3, kids should be getting their blood pressure checked annually, Moxey-Mims says. Various health factors should also be considered to determine if those checks need to happen more frequently, like family history of kidney disease, heart disease or diabetes; “and certainly if the child is obese, then checking it more frequently than that after they hit the age of 3 would be important,” she says. Check, too, with your doctor to see if BP needs to be checked more frequently if the child was born prematurely or for other reasons.
The guidelines note that elevated blood pressure, stage 1 and stage 2 hypertension demand an increasing level of response, from recommending lifestyle changes for the child — including eating right with a heart-healthy diet with reduced salt — more physical activity and addressing weight concerns — where present — to prescribing medication to treat persistent hypertension.
[See: The Best Foods for Lowering Your Blood Pressure.]
Not Just an Adult Problem
According to the Centers for Disease Control and Prevention, about 1 in 3 adults have hypertension. By comparison, the number of kids with high blood pressure is much smaller. Still, national data shows it’s increased in recent decades to about 1 in 29, or 3.5 percent, who now have hypertension, up from an estimated 1 or 2 percent.
Other “adult” health issues, like Type 2 diabetes, have been on the rise amidst the childhood obesity epidemic that has saddled many children with extra pounds that threaten to weigh down their health as they become teens and young adults. “Because of the obesity epidemic, we are seeing more and more teenagers who are obese or diabetic or having high cholesterol, in addition to the high blood pressure,” says Dr. Omar Khalid, a pediatric cardiologist with The Heart Center at Nationwide Children’s Hospital in Columbus, Ohio.
Ideally, lifestyle changes — which are stressed in the latest clinical recommendations — would be enough to bring blood pressure readings back into a healthy range, so that a child doesn’t have to be put on medication indefinitely. To prevent unnecessary treatment, the AAP’s latest BP guidelines emphasize making multiple checks to determine if blood pressure really is high. “In the new guidelines, what we say is that if you have a couple abnormal blood pressures in the office, we should really give you an ambulatory blood pressure monitor, which is basically a device that would be connected to the child for probably a 24-hour period,” Kaelber says. “It would take a whole bunch of blood pressure measurements, while they’re sleeping, at school, eating, to really get a sense of if blood pressures are normal or abnormal outside of the office visit as well.” Many kids, like adults, have so-called white coat hypertension — their blood pressure goes up in the doctor’s office, but is normal elsewhere.
While hypertension is not particularly common in kids, he says it’s still probably among the top five most common chronic issues children face — after weight problems; asthma or breathing problems; behavior problems — particularly ADHD; and skin problems, such as eczema and allergies. While all of those issues are accompanied by signs and symptoms parents would be likely to notice, “pediatric hypertension is a silent disease,” Kaelber says — as is the case in adults.
Experts say regular BP checks are critical for that reason and also because in some cases of what’s called secondary hypertension, there’s an underlying cause. So not detecting the high BP can mean that underlying health concern — such as kidney disease or a congenital heart issue — could go unnoticed and cause more serious problems, like in rare cases kidney failure or heart failure.
Among those with high blood pressure, secondary hypertension is more common in kids than adults. “It’s estimated that probably somewhere in the order of 20 to 30 percent of pediatric hypertension is secondary hypertension,” Kaelber says. “It’s very important to identify the hypertension, because that’s really the sign of another potentially silent disease that the child may have that may be correctable or need intervention.”
[See: The Facts on Heart Disease.]
For kids who have what’s called primary hypertension, where the cause is not known, lowering blood pressure to a normal range helps prevent more serious health issues when they’re adults. As a pediatrician and an internist, Kaelber sees that big picture: Kids who have high blood pressure are more likely to be adults who have high blood pressure and face a range of other health problems. “Those are the people that have early heart disease, heart attacks, early strokes, kidney failure,” he says. “The key here is that you don’t want this disease to go unrecognized or untreated for decades.”
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Tackling High Blood Pressure in Kids originally appeared on usnews.com
