Dear NP

Dear NP,

“Please discuss the screening recommendations for pediatric hypertension. My 14-year-old had a blood pressure of 151/102 during a recent sports physical. I don’t remember his blood pressure being checked at previous medical appointments.”

Dear Reader,

Recommendations for blood pressure screening in children can vary depending on the organization presenting the guidelines. The United States Preventative Services Task Force (USPSTF) is an organization that reviews the evidence for or against screening services.

Currently, the USPSTF recommends against routine screening of blood pressure in children under the age of 18. However, the American Academy of Pediatrics (AAP) has a different recommendation. The AAP recommends checking blood pressure at every well-child visit beginning at age three.

Children with certain risk factors or conditions should have their blood pressure checked at every visit. These include obesity (BMI >95th percentile), kidney disease, diabetes, congenital heart problems and those taking medications that could increase blood pressure.

The current incidence of high blood pressure in children is about 3-4%. Because of the low incidence and the fact that high blood pressure usually occurs in children over the age of 13, the USPSTF feels that screening younger children does not provide a great benefit.

The AAP also recognizes a low incidence of high blood pressure in children. Still, they note that elevated blood pressure in children often leads to metabolic syndrome and persistent high blood pressure as an adult.

There are some challenges with checking blood pressures on children. It can be difficult to get accurate readings due to the placement and size of blood pressure cuffs. Automatic vs. manual blood pressure cuffs will also vary in results.

If an initial reading is high, the measurement should be repeated after allowing the child to rest. Often the blood pressure will normalize at repeat readings.

According to pediatric blood pressure charts, if the blood pressure remains elevated, the initial recommendation is to attempt lifestyle interventions such as a healthy diet, adequate sleep and increased physical activity. Then, reassess the blood pressure after six months of lifestyle interventions.

Blood pressure screening is a routine part of sports physicals for student-athletes. High blood pressure in athletes may increase the risk for heartbeat irregularities or sudden death.

Elevated blood pressure may also be a sign of an underlying cardiac condition. Athletes with uncontrolled high blood pressure may be restricted from play until their blood pressure is under control.

If your child’s blood pressure was elevated during a sports physical, it should be repeated to confirm the reading was not falsely elevated. Often the blood pressure will normalize after resting.

When blood pressures remain elevated on repeat measurement, you should make a visit to have your child evaluated by their primary care provider or pediatrician. Your provider will ensure proper measurement of the blood pressure to determine if it is indeed high.

The level of blood pressure elevation, if it persists, will be assessed and recommendations made for further treatment if needed. They will also determine if athletic participation is appropriate for your child. School sports participation is a valuable activity that encourages physical activity to control weight-related issues such as high blood pressure.

If you have any questions about what screenings are appropriate for your child or what results mean, seek the advice of your personal health care provider.

Dr. Wesley Davis is an Emergency Nurse Practitioner at Crook County Medical Services District and Coordinator of the Family and Emergency Nurse Practitioner program at the University of South Alabama. He encourages readers to send their questions to [email protected]