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How To Manage High Blood Pressure In Children

The definition of high blood pressure in children is not standardized. There is no one magic number which indicates that a child has high blood pressure because as they grow their blood pressure changes continuously before it stabilizes around age 14-16.

Instead, when your child’s blood pressure is higher than the majority of children of the same age, sex and height, then your child is considered to have hypertension.

Just like adults, children are also prone to high blood pressure but unlike adults in most children, there is usually a cause. In more than 90% of adults, no cause of high blood pressure is ever found.

 What Are Symptoms Of High Blood Pressure In Children?

In general, the majority of children have no symptoms when they have high blood pressure. Thus, the condition often goes undetected for months or even years.

When blood pressure becomes very high, the child may sometimes complain of headache and extreme fatigue.

In most cases the high blood pressure is detected on a coincidental examination for another disorder at the clinic or in a hospital.

 

What Causes High Blood Pressure In Children?

In the majority of children, there is a cause for high blood pressure. In most cases, the cause may be related to narrowing of the major blood vessel in the body called the aorta. However, hypertension in the child can also be associated with:

  • Disorders of the heart
  • Disorders of the kidney
  • Cancer of the adrenal gland
  • Abnormal hormonal secretion
  • Obesity
  • Overactive thyroid gland
  • Sleep apnea

In about 5-10% of children, the cause of high blood pressure is never discovered. When a cause is not found, then this is considered to be primary or essential hypertension. This type of hypertension is often prolonged and requires long-term treatment.

Unlike secondary hypertension, which is due to some type of medical disorder and improves after treatment, primary hypertension does not spontaneously disappear.

 

What Are Risk Factors For Hypertension In Children?

There are certain risk factors that make some children prone to high blood pressure.  These risk factors apply predominantly to primary hypertension and include the following:

  • Being overweight
  • Family history of high blood pressure
  • Having high cholesterol levels
  • Having diabetes

Secondary hypertension in children is usually due to some type of medical disorder such as the causes listed above.

Unlike primary hypertension, when the risk factors for secondary hypertension are treated, the high blood pressure resolves.

 

What Are Complications Of High Blood Pressure In Children?

High blood pressure is a silent disease but if it is not recognized it can present with devastating complications. Some of the complications in children include the following:

  • Heart attack
  • Heart failure
  • Kidney disease or failure, leading to dialysis
  • Stroke
  • Visual problems

Once these complications develop, partial recovery may be possible but in most cases the effects are permanent. If the heart is damaged, the child may develop chest pain or shortness of breath and if there is a stroke, it may leave the child with some type of weakness.

 

How Is Diagnosis Of High Blood Pressure In Children Made?

Like in adults, the diagnosis of high blood pressure in children is first made by measuring the blood pressure on several occasions over a few weeks. If the blood pressure continues to remain high, then a diagnosis of hypertension is confirmed. It usually takes three blood pressure measurements at three different visits to make a diagnosis of high blood pressure.

Once high blood pressure is diagnosed, the healthcare provider will perform the following tests to discover the cause:

  1. Check blood work to make sure that the blood sugar, kidney function and blood cell count is normal.
  2. Check the urine for protein. When high blood pressure occurs, kidney damage can result in loss of protein in the urine.
  3. An echocardiogram is done to assess the heart function and structure. In children, the cause of high blood pressure may be a structural problem, with the heart or the large blood vessels (aorta).
  4. Ultrasound will be done to look at the structure of the kidney and look for narrowing of the blood vessels.

If the clinic blood pressure measurements are conflicting, the healthcare provider may use an ambulatory blood pressure monitoring device. The child wears this device and the machine records the blood pressure for 24 hours. The data is then collected and analyzed.

Ambulatory monitoring is ideal for a child who is nervous in the doctor’s office. Anxiety often causes the blood pressure to go up and can lead to an erroneous diagnosis of high blood pressure.

 

How Is High Blood Pressure Treated In Children?

If the child only has mild to moderate elevation of blood pressure, then most healthcare providers will initially recommend changes in lifestyle. This means eating a healthy diet and performing some type of outdoor activity. There is ample evidence showing that these lifestyle changes can help lower blood pressure in children.

Children do not need to enroll in any formal exercise program but should be encouraged to play outside, swim, walk and remain active. Forcing a child into exercise usually leads to non-compliance.

 

What Type Of Medications Are Used To Treat Hypertension In Children?

The non-medical therapy for treatment of high blood pressure is usually done for about three months to determine the response. Medications are only prescribed if this non-medical therapy fails to work after 3-6 months.

There are several medications to treat high blood pressure in children and they all work well. The type of medication selected depends on the degree of blood pressure elevation and once a day dosing. Children generally do not remain compliant with medications that are supposed to be taken more than once a day.

The duration of medication use for high blood pressure in children depends on the response. In most cases, the use of medication is temporary because as the child grows up, the blood pressure may subside spontaneously. For example if the high blood pressure is due to obesity, with weight loss the blood pressure will decrease and there is no need for medications.

 

What Can Be Done At Home To Reduce Or Prevent Hypertension In Children?

To prevent or treat high blood pressure in children at home, the following should be undertaken:

  1. Control the child’s weight. Encourage exercise and make sure that he or she eats a healthy diet. Avoid too much processed or synthetic foods
  2. Decrease the amount of salt in the diet. Children should not consume more than 1,000 -1, 200 mg of salt per day.
  3. Encourage fruits and vegetables instead of high calorie snacks like chips or candy
  4. Encourage physical activity. This means being physically active for at least 45-60 minutes everyday.
  5. Because children hate doing things alone, involve the entire family with exercise and dietary changes.

 

How To Tell A Child They Have Hypertension

Because high blood pressure is a silent disorder it is often difficult for children to comprehend what they have. Parents should tell their child they have a temporary disorder which may or may not require medication, depending on how the body reacts to lifestyle changes.

The child should be told that they need to eat a healthy diet and remain physically active. Reassurance and keeping the child stress free are key factors when managing high blood pressure.

If you suspect that your child has hypertension, then a visit to the doctor is highly recommended. There are usually no special preparations required before the visit but you should take the list of blood pressure recordings and medications with you.

Since time is limited at the doctor’s office, also prepare a list of questions that you want answered like what type of treatment? For how long? What foods to eat? What exercise can he or she perform? And what type of testing will be required. Remember this is the time to ask questions so if you do not understand something, ask.

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