The problem of arterial hypotension (low blood pressure) in children has become more common than before. Evidence suggests that hypotension is even more common in children than in adults. Unfortunately, this problem also affects newborns. For a child, blood pressure is considered low, the upper limit of which is no more than 100, and the lower limit is no more than 60. The risk group is schoolchildren, among whom girls are more susceptible to this condition. But blood pressure in children can be not only low, but also high. In this case, it is customary to talk about hypertension. Arterial hypertension, hypertension in children - a persistent increase in blood pressure above the 95th centile of the distribution scale of blood pressure values for a specific age, gender, weight and body length of the child. Normal blood pressure is considered to be values of systolic and diastolic blood pressure that do not go beyond the 10th and 90th centiles.
Causes
It is not always possible to find pathological reasons for a persistent decrease in pressure. This usually happens with primary hypotension, which, however, has its own reasons:
- asthenic physique;
- puberty;
- hereditary predisposition;
- problems during pregnancy and childbirth;
- features in the child’s character, for example, a tendency to depression;
- overwork;
- stress.
Secondary hypertension has causes that are associated with diseases of internal organs and systems: kidney disease, pneumonia, cardiovascular disease, adrenal disease, etc. Also, this form of hypotension can develop due to the use of certain medications, especially considering that children's bodies are most sensitive to medications. But a child’s blood pressure can increase for various reasons. This may depend on hereditary, external factors, and specific age. If a pregnant woman smokes during pregnancy, the risk that the breastfeeding baby will have health problems increases. Diseases of the endocrine system also cause hypertension. Children with VSD are considered potential hypertensive patients. An overdose of some nasal drops leads to a narrowing of blood vessels not only in the nose, but even in the arteries. Because of this, blood pressure increases. It has been noted that high blood pressure is often characteristic of those children who are obese or overweight. Poor nutrition, low physical activity, sedentary lifestyle, stress, school workload. All this can cause health problems.
How to measure a child's blood pressure
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Measuring blood pressure in children has its own characteristics and is slightly different from a similar procedure in an adult.
- It is recommended to carry out the procedure in the morning, an hour after eating or walking. The child must visit the toilet and not be exposed to stress.
- The first time you take a measurement, you need to use both hands to determine where the pressure is higher.
- For a child under 2 years of age, the procedure is carried out in a lying position, for children older than this age - sitting, the legs should not hang down (if the baby does not reach the floor, install a stand).
- To measure, use a cuff according to size, since the component part of the tonometer for adults can distort the results of the study. For accurate measurement, the cuff should be ¾ of the distance from the armpit to the bend of the elbow.
Further, the procedure is no different from the usual sequence in adults. A phonendoscope is applied to the vein in the elbow, air is pumped in with a bulb and, after deflating the air, the beginning (systolic pressure) and end of the pulsation (diastolic blood pressure) are noted.
Blood pressure in children is always lower than in adults. The younger the body, the higher the elasticity of the vessels and the wider their lumen, which means that the pressure of blood on the lining of the arteries is minimal. As the child grows up, blood pressure gradually increases and by the end of adolescence reaches stable levels (110–120/70–80). Blood pressure in childhood can be affected by external factors - stress, overwork, trauma, physical activity, or internal diseases - cardiac, endocrine, renal pathologies.
Symptoms
If hypotension manifests itself in a newborn, then the parents do not have any special problems, because it is difficult to determine from his condition that there are health problems. This is explained by the fact that the child sleeps a lot, rarely cries, and is in constant peace. Children who have decreased muscle tone, legs and arms can extend more than 180 degrees at the joints. In addition, the following symptoms are observed: a delay in the rate of motor development and impaired swallowing and sucking. Dizziness, fainting, nosebleeds, emotional lability, decreased performance, joint and muscle pain, sudden deterioration in health, and headache may also occur. With a slight increase in blood pressure, the child’s health may be good. Although the child may quickly get tired and irritated. But if the pressure rises strongly, the child will always feel unwell. Among his complaints are the following: headache, dizziness, pain in the heart, palpitations, memory impairment. If a hypertensive crisis occurs. Symptoms such as severe headache, nausea, blurred vision, convulsions, impaired consciousness and others may be observed.
ANNEX 1
24-hour BP monitoring diary
Child's full name _________________________________________________
Date of birth _________________ Age (years) ____________________
Weight ___________ Height __________ Body mass index (kg/m2) __________
FULL NAME. mother of the child _____________________________________________________
Address: ________________________________________________________
Telephone: ______________________________________________________
Study start date ________ Study start time ________
Cuff: on the right hand on the left hand.
Prescriptions (drug, dose) – _____________________________________
| Time | Kind of activity | Complaints | |||||||||
| (hour) | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | Notes |
| 06–07 | |||||||||||
| 07–08 | |||||||||||
| 08–09 | |||||||||||
| 09–10 | |||||||||||
| 10–11 | |||||||||||
| 11–12 | |||||||||||
| 12–13 | |||||||||||
| 13–14 | |||||||||||
| 14–15 | |||||||||||
| 15–16 | |||||||||||
| 16–17 | |||||||||||
| 17–18 | |||||||||||
| 18–19 | |||||||||||
| 19–20 | |||||||||||
| 20–21 | |||||||||||
| 21–22 | |||||||||||
| 22–23 | |||||||||||
| 23–24 | |||||||||||
| 00–01 | |||||||||||
| 01–02 | |||||||||||
| 02–03 | |||||||||||
| 03–04 | |||||||||||
| 04–05 | |||||||||||
| 05–06 | |||||||||||
where, types of activities: 1 – sleep, 2 – eating, 3 – taking medications, 4 – lying down, 5 – emotional stress, 6 – physical activity; complaints: 7 – headaches, 8 – dizziness, 9 – palpitations, 10 – fatigue
Diagnostics
To make a diagnosis, first of all, blood pressure measurements are needed. This is usually done in a sitting position for the first half. The measurement occurs three times, the interval between these is three minutes. Also, it is not done immediately after mental or physical stress, but after an hour has passed. In addition, the following diagnostic methods are used: ECG, ECHO-kg, ABPM, study of autonomic homeostasis, EEG registration, psychological testing, clinical and biochemical blood tests, consultation of the necessary specialists in order to exclude secondary arterial hypotension. To confirm the diagnosis of arterial hypertension, daily monitoring and tests with different types of stress are used. During the study, it is important to identify the cause of the increase in pressure if hypertension is secondary. This is what helps the doctor prescribe effective treatment. If the cause of hypertension is not eliminated, treatment measures will not give the desired effect, the result will be temporary.
INDICATIONS AND CONTRAINDICATIONS FOR THE USE OF THE METHOD
The main indications for ABPM are:
1. Arterial hypertension.
2. Arterial hypotension.
3. Syncope.
4. Short-term, difficult to register during random measurements, fluctuations in blood pressure.
5. White coat hypertension.
6. Hypertension refractory to drug therapy.
There are no absolute contraindications to the use of the ABPM method in pediatrics. Possible complications include:
1. Swelling of the forearm and hand.
2. Petechial hemorrhages.
3. Contact dermatitis.
In order to prevent the occurrence of petechial hemorrhages, ABPM should not be administered to children with thrombocytopenia, thrombocytopathy and other disorders of vascular-platelet hemostasis during an exacerbation. To prevent the development of edema of the distal part of the limb and contact dermatitis, the cuff should be placed not on the bare shoulder, but on the sleeve of a thin shirt.
Treatment
Treatment can be medicinal or non-medicinal. If arterial hypotension occurs in a labile form, then preference is given to the second type of treatment, which includes several methods. It is necessary to normalize the daily routine, which includes the child’s correct combination of study and rest. It is important to take timely breaks. This also includes quality sleep at night, as well as daytime rest. Don't forget your daily walks. A child should be in the fresh air for about two hours a day. Meals should be taken four to six times a day. At the same time, there should be a sufficient amount of salt in the food. It is important that the products contain a sufficient amount of nutrients and microelements, which are very important for the child’s body. It is important to maintain optimal water regime. Massage has a good effect. Recommended area: hands, collar area and calf muscles. If such methods are insufficient or childhood hypotension has progressed to a more serious method, the doctor will prescribe the necessary medications. Treatment of hypertension depends on many factors. If arterial hypertension in children and adolescents is accompanied by a slight increase in pressure, non-drug therapy is used. If a child is overweight, it is necessary to reduce body weight. This is achieved by increasing physical activity and normalizing nutrition. If the school assigns a lot of homework, you need to make sure that this does not affect the health and condition of the student. If lifestyle changes do not lead to a decrease in blood pressure or the levels are high, drug treatment is prescribed. Antihypertensive therapy is also prescribed for those children who suffer from diabetes mellitus and chronic kidney diseases. Most of the drugs prescribed for adults are also used for younger patients. But doses and medications are always selected individually.
Normal blood pressure in children
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Normal blood pressure in children is very different from that in adults.
The values are influenced by the child’s age, which also determines the following parameters:
- the degree of elasticity of the walls of blood vessels;
- capillary mesh size;
- lumen in arteries and veins.
The younger the body, the better the condition of the circulatory system and the lower the blood pressure - blood moves freely through the vessels with minimal pressure on their walls.
The formation of blood pressure develops dynamically in the first 12 months after birth. During this period, it steadily increases by 1 mm Hg. Art. every 4 weeks. After a year the process of increase slows down.
Table “Normal blood pressure indicators in children under one year of age”
| Child's age | Reference blood pressure values (mmHg) | |
| Systolic | Diastolic | |
| First 2 weeks | 60–95 | 40–50 |
| 2 to 4 weeks | 80–110 | 40–73 |
| 4 to 8 weeks | 82–112 | 40–75 |
| From 8 weeks to 6 months | 85–115 | 50–70 |
| From 6 months to 1 year | 90–115 | 50–75 |
From birth to 5 years, the level of child pressure does not differ between girls and boys. From 6 to 9 years of age, blood pressure levels in males are slightly higher, and in adolescence they become slightly lower.
Table "Normal children's blood pressure by age"
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| Number of years | Limit values of the norm (mm Hg. Art.) |
| From 1 to 2 years | 90–112/60–73 |
| From 2 to 4 years | 100–113/60–75 |
| From 4 to 6 years | 100–115/60–77 |
| From 6 to 8 years | 100–120/60–78 |
| From 8 to 10 years | 100–123/60–80 |
| From 10 to 12 years | 110–125/70–84 |
| From 12 to 16 years | 110–135/70–85 |
From 7 to 16 years the indicators gradually increase:
- in girls - by 1 mm Hg. Art.;
- in boys – by 1.5–2 mm Hg. Art.
Important! Due to the growth of the body, childhood activity and adolescence, large fluctuations in blood pressure are possible (20–25 mm Hg). If deviations greatly exceed acceptable limits, it is worth showing the child to a doctor.
Change in indicators at 7-8 years
For children at this age, “jumps” in blood pressure are more often associated with increased psychological stress and high loads. Mostly they complain about feeling unwell after school, attending a club or section. According to medical statistics, in children seven years of age and older who study in specialized schools (mathematics, language, physics and mathematics), hypertension is diagnosed five times more often, and the blood pressure norm according to the table does not correspond. Such indicators are associated with high loads and insufficient rest.
Recording indicators
Diagnosis of arterial hypo- or hypertension is based on threefold measurement of indicators. To correctly measure blood pressure in children, it is necessary to select a tonometer according to the child’s age. The table values will help you choose the optimal cuff width, according to the All-Ukrainian Health Organization.
| Age category | Cuff width (cm) |
| Newborns and infants | 2,5 |
| 1–3 years | 5–6 |
| 4–7 years | 8–8,5 |
| 8–9 years | 9 |
| 10–13 years | 10 |
| 14–16 years old | 13 |
How to measure blood pressure in children and adolescents:
- It is necessary to give the child time to adapt to the conditions in which the measurement will take place (5–10 minutes).
- The arm on which the measurement will be taken should be at heart level, the back should rest against the back of the chair, and the legs should not be crossed. The sleeve should not squeeze the arm above the place where the cuff is fixed.
- The stethoscope is applied to the area of the ulnar fossa at the site of the projection of the brachial artery.
- The cuff is fixed 2.5 cm above the cubital fossa. Close the bulb valve, making sure that the readings are at 0 mmHg. Art.
- Inflate air into the cuff until the pulsation disappears, adding 20–30 mmHg. Art. Next, the valve of the bulb is slowly opened, carefully monitoring the number at which the pulsation becomes audible again. This is the first indicator - systolic pressure.
- The moment the pulsation disappears is the second indicator (diastolic pressure).
- Record the indicators on paper or in medical documentation.
WHAT TO DO IF A CHILD HAS HIGH BP?
If this was discovered during an examination by a doctor, then keep in mind that children have so-called “white coat” hypertension due to the child’s emotional lability. If this turns out to be not an isolated case, then you should definitely keep a diary where you can record the child’s blood pressure readings. Moreover, it is necessary to measure at the same time. It is also additionally necessary to conduct examinations to assess damage to other organs (the so-called target organs): clinical blood test, clinical urine test, biochemical blood test with assessment of the lipid spectrum, electrolytes, glucose and renal markers, ECG, echocardiography, fundus examination , Ultrasound of the kidneys with assessment of blood vessels, 24-hour blood pressure monitoring.
Based on the results of the examination, treatment is prescribed with recommendations for control and lifestyle. In short, if a child has high blood pressure, it is recommended that he:
- first of all, normalization of lifestyle,
- healthy 8-10 hour sleep, regular physical activity in the form of walking, running, swimming, skating, skiing, cycling 30-60 minutes a day, limiting weight lifting (static loads),
- limiting work on gadgets to 30-40 minutes a day,
- proper nutrition (limiting table salt, reducing light carbohydrates),
- normalization of weight in case of excess.
If a hypertensive crisis occurs with a worsening condition, call an ambulance; it is not recommended to take medications on your own if they have not previously been selected by a doctor; incorrect dosage selection can worsen the condition!
Correct measurement
To correctly determine the pressure in a 12-year-old child, you need to start by studying the correct algorithm for the procedure. It consists of the following:
- the width of the device cuff must be at least 40% of the arm circumference;
- the cuff fits the arm 80–100%;
- measurements are taken alternately on both hands twice, with an interval of 5–10 minutes;
- with regular pressure drops in children, it is recommended to take measurements twice a day for a week, and write the results in a notebook;
- do not measure indicators immediately after a heavy lunch or active physical activity - half an hour should pass after eating food and 10-15 minutes after intense movement;
- choose a sitting position for the procedure;
- the hand should lie on the table top, and the child sits silently, does not talk or move.
This is the only way to record correct results, without errors. By the way, to measure a child’s blood pressure it is better to use a manual rather than an automatic tonometer. Such devices are more accurate, and the measurement error is only 3–5 units.
