High and Low Blood Pressure in Children: A Guide for Parents

Childhood Hypertension and Hypotension

Hello Doctor: My daughter is 5 years old.
On the evening of January 4th, I measured her blood pressure, which was "139/119" with a heart rate of 51.
Is this normal? Could you please provide the correct measurement method? Thank you! My daughter's information: height: 109 cm, weight: 16 kg.

JO, 20~29 year old female. Ask Date: 2004/01/05

Dr. Zhao Yongkang reply Pediatrics

Dear Mom,
A.
1.
Generally, for children aged 5-6 years, the average resting heart rate is approximately 75-115 beats per minute.
2.
The average blood pressure typically has a diastolic pressure of around 60-75 mmHg and a systolic pressure of about 95-115 mmHg.
Therefore, it seems that your child's heart rate is too low, and the blood pressure is too high.
It is advisable to consult a pediatric cardiologist for a thorough examination.
Our pediatric cardiology department, led by Dr.
Huang Bi-Tao, has outpatient services available on Wednesday morning, January 7th, which you may find useful.
B.
1.
When measuring blood pressure, it should be done while the child is calm and resting.
The inflatable cuff should cover about two-thirds of the upper arm length.
Typically, you may be using an electronic blood pressure monitor; if using a traditional mercury sphygmomanometer, a stethoscope is needed for assistance, which requires some technique.
2.
To measure the heart rate, generally, when the child is calm, you can palpate the child's wrist, specifically on the radial side near the thumb.
Thank you for your letter! Wishing you well.
Sincerely,
Dr.
Zhao Yong-Kang
Director of Pediatrics, Hsinchu Hospital

Reply Date: 2004/01/05

More Info

Understanding blood pressure in children is crucial for parents, especially when abnormal readings are observed. In the case of your 5-year-old daughter, a blood pressure reading of 139/119 mmHg is significantly elevated for her age. To put this into perspective, normal blood pressure ranges for children vary by age, height, and gender. For a child aged 5 to 6 years, the average systolic (the top number) blood pressure is typically between 95-115 mmHg, and the diastolic (the bottom number) is around 60-75 mmHg. Therefore, your daughter’s reading indicates hypertension, which requires further evaluation.

Importance of Accurate Measurement
Before delving into the implications of her blood pressure reading, it’s essential to ensure that blood pressure is measured correctly. Here are some guidelines for accurate measurement:
1. Preparation: Ensure that the child is calm and seated comfortably for at least five minutes before taking the measurement. Avoid any physical activity or emotional stress prior to the measurement.

2. Equipment: Use a pediatric-sized cuff that covers about 2/3 of the upper arm. If the cuff is too small or too large, it can lead to inaccurate readings.

3. Positioning: The child should be seated with their back supported, feet flat on the floor, and arm at heart level. The arm should be bare, and the cuff should be placed directly on the skin.

4. Technique: If using an electronic blood pressure monitor, follow the manufacturer’s instructions. For manual measurements, a stethoscope is needed to listen for the heartbeats while inflating and deflating the cuff.

5. Multiple Readings: It’s advisable to take multiple readings (at least two or three) and average them to get a more accurate assessment.

Understanding the Implications
Given your daughter’s blood pressure reading, it is important to consult a pediatric cardiologist or a healthcare provider specializing in children’s health. Elevated blood pressure in children can be caused by various factors, including obesity, high salt intake, lack of physical activity, or underlying health conditions.
In your daughter’s case, her heart rate of 51 beats per minute is also on the lower side for her age, where a normal resting heart rate for children aged 5-6 years typically ranges from 75 to 115 beats per minute. A low heart rate, especially when combined with high blood pressure, can indicate an underlying issue that needs to be evaluated.

Potential Causes and Next Steps
1. Lifestyle Factors: Assess her diet and physical activity levels. A diet high in sodium or low in potassium can contribute to high blood pressure. Encouraging a balanced diet rich in fruits, vegetables, and whole grains, along with regular physical activity, can help manage blood pressure.

2. Family History: Since you mentioned a family history of hypertension, it’s essential to monitor her blood pressure regularly. Genetic predisposition can play a significant role in the development of hypertension.

3. Further Evaluation: The healthcare provider may recommend additional tests, such as blood tests, an electrocardiogram (ECG), or an echocardiogram, to rule out any underlying conditions.

4. Monitoring: Regular follow-up appointments will be necessary to monitor her blood pressure and overall health. Keeping a log of her blood pressure readings at home can be beneficial for the healthcare provider.

Conclusion
In summary, your daughter’s blood pressure reading is concerning and warrants immediate attention from a healthcare professional. Accurate measurement techniques are crucial for reliable readings, and understanding the implications of high blood pressure in children is vital for their long-term health. Early intervention can prevent potential complications and promote a healthier lifestyle for your child.

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