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Blood pressure in children:
How and when to measure it?
My name is Hannah
Bellsham-Revell,
and I'm a paediatric
cardiologist at
Evelina London
Children's Hospital.
0:10
Various ranges are available.
In this series of lectures,
I will use the UK PEWS.
Blood pressure centiles
are also available
by sex and height and
should be used to
assess if hypertension
is suspected.
0:23
Normal blood pressure ranges
of the systolic by age.
0-11 months, 70-90mmHg.
1-4 years, 80-100mmHg.
5-12 years, 90-110mmHg.
More than 13 years, 100-120mmHg.
It is important to
look at trends,
not just isolated numbers,
and you may see a response to
treatment in blood
pressure response,
for example, a low
blood pressure
increasing in sepsis
after fluids.
0:54
Identification of hypertension.
There are many causes
of high blood pressure
that are not real, for example,
anxiety, running or activity
just before measuring,
a cuff that is too small,
or an active child.
Therefore, an assessment
needs to be made
on serial readings and can be
very challenging
in small children.
Automated machines are
also not totally accurate,
so ideally, manual
blood pressure
using a Doppler is
the gold standard.
1:20
Causes and management
of hypertension.
Clinical examination
is essential.
In particular,
differences in the
radial, brachial,
and femoral pulses.
Coarctation of the
aorta will have
weaker femoral pulses with
lower blood pressure in the
lower limbs in the right arm.
However, it can be a sign of
thyroid disease or
neurological issues.
Elevated intracranial
pressure can cause
elevated blood pressure
and low heart rate,
which are critical signs.
Blood tests are important,
looking for kidney issues
or hyperthyroidism.
Rarely, it can be something like
a phaeochromocytoma
driving hypertension.
It is important to discuss
with the renal team,
as in paediatrics, most
management is by the renal team,
not cardiology, as most
of the causes are renal.
It's important to correct
the cause if possible,
and the medical therapy is very
similar to that in adults.
It's important to look
at cardiac function,
looking for hypertrophy
of the heart,
and things like obesity
will need managing.
Orthostatic hypotension.
