Hypertension in Children

HYPERTENSION IN CHILDREN

A few moments with your little baby could prove to be a stress buster for you. However, these little bundles of joy could suffer from hypertension too. Alarming but unfortunately true! High blood pressure in babies could be a cause of concern for the parents, but shying away from the problem will definitely not help.



What is Blood Pressure?

This is pressure your blood exerts against the walls of the arteries each time your heart pumps blood as the blood travels to all parts of the body. Blood pressure is generated by the pumping action of the heart. Stress, anxiety and strenuous activity could increase the blood pressure.



How to Measure Blood Pressure?

Blood pressure is measured with an arm cuff that is inflatable and a gauge that measures the pressure. It is important to know how to read blood pressure in order to monitor it. The first, higher or upper number measures the pressure in the arteries when the heart beats and is called the systolic pressure. The lower reading measures the pressure in the arteries between beats and is called the diastolic pressure.

What is The Normal Blood Pressure for a Child?

Normal blood pressure measured for a child is based on three factors – age, gender and weight. A blood pressure of 64/41 in a newborn is considered as normal. For a child from 1 month up to 2 years old, it is 95/58. It is normal for these numbers to vary. Your doctor will determine if your child is suffering from hypertension if the reading is high after checking it three times and regular monitoring will be recommended by your doctor.




What is High Blood Pressure?

Under normal condition, the heart pumps blood all over the body through the blood vessels which widen and contract to maintain and regulate the flow of blood. When the blood pushes too hard against the blood vessels causing damage to the vessels, heart and other organs it is termed as high blood pressure. “Hypertension” means high blood pressure greater than 95 percent according to age, weight and height.

Causes of Hypertension in Children

Inherited/Genetic form or primary hypertension is the most common reason for high blood pressure. It is common in overweight and obese children and adolescents. The cause of primary hypertension is unknown. Kidney abnormality, narrowing of arteries to kidneys, congenital heart condition, rare tumours of the adrenal gland are some other causes of high blood pressure. These forms are called as secondary hypertension as underlying causes can be identified.





Symptoms of High Blood Pressure in Kids

Symptoms may not always be displayed however could be conspicuous in the following ways

  • Bluish colour of the skin
  • Shortness of breath
  • Slow growth and minimal weight gain
  • Recurrent urinary tract infections
  • Paleness and tiredness

SYMPTOMS

Diagnosis of Childhood Hypertension

If your child is diagnosed with hypertension after three readings, your doctor may perform these tests to see if the underlying condition causing the increase in blood pressure




  • Blood test to check sugar levels, kidney function and the blood cell count
  • Urine test
  • Echocardiogram- a test to check the blood flow through your child’s heart in case there is a structural heart problem causing the issue
  • Ultrasound of kidneys

Ambulatory monitoring of blood pressure will be recommended by the doctor if your child’s blood pressure is high for over a year or Stage 1 hypertension over three clinical visits. In this case, the child will wear a device that measures their blood pressure throughout the day. This will help check if the pressure is high owing to temporary factors like being in the presence of a doctor.

Types of Hypertension

A systolic or diastolic blood pressure level over the 95th percentile or greater based on three separate readings on an average is defined as hypertension. Once diagnosed it is classified as follows to assist evaluation and treatment





  • Normal: A reading below the 90th percentile is normal
  • Pre Hypertension: A reading between 90th to <95th percentile or >or= 120/80mm Hg +
  • Stage 1 Hypertension: A reading between 95th to 99th percentile in addition to 5 mm Hg
  • Stage 2 Hypertension: A reading > 99th percentile in addition 500 Hg

*Please note these classifications are based on sex, age, height and weight measured on three separate occasion

+ If 120/80mm Hg is in the 95th percentile or greater then it is classified as hypertension.




Risks and Complications of High Blood Pressure in Children

  • High blood pressure increases the workload of the heart, squeezing blood amidst high pressure causing the pumping chamber of the heart to become enlarged and thickened.
  • The left side of the heart can become larger or thicker leading to left ventricular hypertrophy resulting in a heart attack.
  • Arteries in the kidneys could be damaged making them narrow and decreasing the blood supply to the kidneys hampering the function of the kidneys.

KIDNEY DAMAGE

  • Arteries supplying blood to the brain could be damaged by the weakening of the walls causing bleeding and leading to a stroke.
  • It could cause damage to the eye by causing arteries to become narrow and twisted impairing vision permanently

How to Treat Paediatric Hypertension?

Work closely with your child to chalk out a treatment plan for treating hypertension. Some guidelines

  • Dietary Plan: The DASH diet includes eating less fat and saturated fats and substituting it with fruits, vegetables and whole grain food. Limit salt intake and work towards widening the food palate around the dietary regime.
  • Weight control: Obesity increases the risk of hypertension. Get your child to exercise regularly and eat appropriately to restrict weight gain.
  • Avoid Tobacco Smoke: Passive smoking could induce high blood pressure in your child so avoid smoking.
  • Medications: If lifestyle changes don’t help, your doctor will prescribe a combination of drugs as follows:

a. Diuretics to reduce the amount of fluid in blood by getting rid of excess sodium
b. Alpha blockers, calcium channel blockers to keep the blood vessels from tightening
c. Beta-blockers to prevent the body from making the stress hormone- adrenaline





Tips to Help a Child with Blood Pressure

  • Limit the amount of time your child spends on watching TV and gadgets
  • Make changes to their diet by limiting salt intake and reducing fried food
  • Get your child to exercise for a few minutes every day
  • Ensure you get your child’s blood pressure checked as recommended by the doctor.

How to Prevent High Blood Pressure in Kids?

Primary hypertension could be caused by genetic factors. But one can certainly try and prevent high blood pressure in kids. Reduce the time kids spend on watching TV and other electronic devices, monitor their diet and reduce processed and fried foods. Aim to control weight by regular exercise. Routine visits to the doctor will help monitor their blood pressure via the paediatric hypertension chart to single out any irregularities.

By working closely with your child and health practitioner and developing a comprehensive health plan you can definitely monitor and regulate your child’s blood pressure level and lead a healthy life.




Also Read: Heart Murmur in Babies & Children