Doctors' Due Diligence: Measuring Kids' Blood Pressure
There have been hints that the obesity epidemic's rise has slowed a bit among certain populations, but for the most part, it continues to dominate American health. One third of children and teenagers are now overweight or obese. And researchers forecast as many as half of our nation's population could be obese — not overweight but obese — by 2030.
With obesity comes a host of health-related problems: diabetes, high blood pressure, heart disease and even certain cancers. Perhaps most worrisome of all, pediatricians report seeing the beginning of these diseases — previously considered problems among adults only — in children as young as 3.
And this is why the American Academy of Pediatrics and federal health officials recommend that doctors routinely screen children for high blood pressure. But diagnosing hypertension in children is more complicated than it is among adults.
"In adults, anything over 140 over 90 is considered abnormal," says family physician Dr. Margaret Riley with the University of Michigan Medical School. Not so for kids.
Normal blood pressure values for children and adolescents are based on age, sex and height. This means doctors need to not only measure a child's blood pressure but also compare it to standardized charts that indicate what's normal for children based on age, sex and height.
"A normal blood pressure for [a 15-year-old boy] is different from that of an 8-year-old girl," Riley says.
She recently published a review of available data in the journal American Family Physician to remind doctors about the importance of not only taking children's blood pressure but also comparing it to standardized tables.
Earlier data show doctors often overlook taking a child's blood pressure during routine visits. Among children eventually diagnosed with high blood pressure, only 26 percent of them had it written in their medical records.
"A physician often will put the blood pressure value in their notes, but they won't address it as high because they won't have recognized it as an abnormal value for that specific child," Riley says, adding, "I think clinicians are used to seeing a number like 100 over 60, and that looks good at first glance, but if you actually look at that for a specific child's age and height, then it may be high for them."
Dr. Reginald Washington, a pediatric cardiologist at Rocky Mountain Hospital for Children, says not diagnosing high blood pressure early can set off a dangerous chain reaction.
"The problem is the body doesn't forgive this; so, if you have high blood pressure or cholesterol as a child, you're setting yourself up for premature problems," says Washington, adding that patients can have strokes in their 20s or 30s if they have high blood pressure that's untreated.
According to one estimate, about 2,000 children and teens suffer strokes every year as a result of hypertension. But the good news, says Washington, is that medication is generally not needed for this age group. Simple lifestyle changes can do the trick. Cutting down on high-fat foods and high-sugar drinks, along with active family outings, can make a big difference, he says. And, because they have higher metabolism, kids have an easier time shedding pounds than adults.
Washington adds that families are often more motivated when their child's health is at stake. Parents should model healthy lifestyles, too, says Riley, by exercising regularly and eating as few processed foods as possible.
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