Since many health problems, including cardiovascular diseases, originate in childhood, the current epidemic of childhood obesity in the United States has led many medical experts to re-examine and update their recommendations for measures to help protect children’s health. In order to detect potential medical problems as early as possible, the American Academy of Pediatrics has endorsed the recommendations of a national children’s health group calling for blood pressure screenings to begin for most children at age three.
Jennifer Cheng, M.D., pediatrician at Duke University Medical Center, said the new guidelines reflect the health community’s concern about a growing health crisis among U.S. children, especially the incidence of childhood obesity.
“Part of the impetus for this change is probably the increased incidence of pediatric obesity,” Cheng said. “We are dealing with a major epidemic. One out of three children is either overweight or obese. We are seeing rising rates of obesity, hypertension and diabetes.
“Blood pressure monitoring should be done annually for most children and even earlier for children with underlying medical conditions, such as heart disease, renal problems, endocrine or metabolic disorders. If the reading is abnormal, it should be repeated on at least three different occasions, to document that truly is a problem.”
Cheng says screening methods for small children are similar to those for adults, with certain adjustments.
“It is done in the same manner, however standards differ for children,” she explained. “Blood pressure values for children depend on their age, gender and height. Because blood pressure actually increases with age, this also helps to avoid misclassifying children at the extreme ends of the growth spectrum, when they may actually not actually have hypertension.”
While high blood pressure can ‘run in families,’ Cheng said the causes of the condition in children are actually quite complex.
“We don’t know the exact cause of what we call essential hypertension just yet. It probably is a result of the interplay of multiple factors, including genetic predisposition and environmental factors.
“Basically a normal reading is a systolic and diastolic blood pressure that fall within the 90th percentile for age, gender and height. A hypertensive child has a blood pressure that is at the 95th percentile or greater. A child who is considered ‘pre-hypertensive’ has a blood pressure that is between the 90th and 95th percentile for age, gender and height.”
Cheng said early diagnosis, lifestyle changes and medication if needed can help prevent many long-term diseases. She added that families can play a key role in helping manage a child’s blood pressure.
“We want to focus on things families can do at home, especially eating a sensible diet and exercising. Lifestyle modification can definitely be a very effective tool in preventing and treating hypertension, if it’s not severe or associated with other medical problems. If that fails, medications are available. However they are not without side effects and should not be used except in special situations.
“A lot of these risk factors begin in childhood and if undetected they end up causing severe, significant organ damage in multiple systems: the heart, the eyes, the kidneys. It can be a major health problem for a lot of these young children.”
