How to Know if Your Child Has High Blood Pressure

Four Parts:Determining if Your Child is at RiskMonitoring Your Child’s BP at HomeRecognizing Symptoms of Severe High Blood PressureTaking Your Child to Get Evaluated

The number of children diagnosed with high blood pressure is on the rise. Currently, between 2% and 5% of children are found to have hypertension, most commonly as a result of childhood obesity. This article will help you to understand the causes, symptoms and risks of high blood pressure in children - just see Step 1 below to get started.

Part 1
Determining if Your Child is at Risk

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    Understand why high blood pressure (BP) is dangerous. Your heart and arteries are subjected to pressure 24 hours a day, 365 days each year. Inevitably, there is some wear and tear on both as we age.
    • However, if BP is too high, this normal wear and tear speeds up. The heart and blood vessels become more likely to undergo damage. Certain other organs also become particularly vulnerable to injury from high blood pressure - most notably the brain and kidneys. Another term for high BP is hypertension.
    • If BP is too low, on the other hand, the body’s organs do not receive the blood circulation they need to function properly.
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    Be aware that diet and lifestyle can cause hypertension. Minimal exercise and more-than-minimal fast food are the most common cause of high blood pressure in children. The main factors that cause high blood pressure in children are:
    • The tendency to retain salt (sodium) and water increases the volume of fluid in the body, including within blood vessels. The greater the volume, the greater the pressure. This is why many people with high BP restrict the salt in their diet and take medications to eliminate salt via the kidneys (diuretics).
    • The activation of several hormones and kidney nerve signals results in the constriction (narrowing) of arteries carrying the blood. The greater the narrowing, the greater the pressure. Over time these people develop stiffer arteries, leading to greater demands on the heart, and greater need for higher pressures to propel the blood through the body.
    • Obese children are at greater risk. However, not all children with high blood pressure are obese, so don't discount symptoms if your child's weight is average or below average.
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    Understand that some medications may cause your child to develop high blood pressure. In otherwise healthy children, it is not common for medications to cause high blood pressure, but it can happen.
    • Concerns often arise when a child taking methylphenidate (Ritalin) or other stimulants for ADHD is found to have elevated BP. Although this drug may increase BP, it is usually only a mild increase. Nevertheless, it would be sensible to test the child's blood pressure off methylphenidate to be sure it is not causing the problem.
    • Other, less commonly used medications can cause high BP, including the immunosuppressive drugs prednisone (and related steroids), tacrolimus, and cyclosporine.
    • Many other medications, over-the-counter drugs, or herbal/nutritional supplements may be able to raise BP but this more commonly occurs in someone who already has hypertension for other reasons. Be sure to give your provider a complete list of these, particularly if BP is elevated.
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    Be aware that some infants can be at a higher risk of developing high blood pressure. Infants and toddlers can have hypertension. Identifying hypertension depends on increased parental awareness of higher risk situations, or the appearance of the symptoms described in section 3 below. Some conditions that frequently cause high blood pressure in infants and which require particular attention include:
    • Infants born prematurely, with complicated medical courses.
    • Infants who have prematurity-related lung disease.
    • Newborns of mothers using addictive drugs during pregnancy (from the infant’s drug withdrawal)
    • Infants or children with heart murmurs.
    • Infants with known kidney or urinary tract abnormalities.
    • Infants with abnormal skin pigmentation.
    • Any child with a family history of polycystic kidneys
    • Children with unexplained seizure disorders.

Part 2
Monitoring Your Child’s BP at Home

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    Learn how to monitor your child's BP at home. If your child has high blood pressure, learn to measure it at home. Learning to monitor your child’s blood pressure at home can help to get a more accurate reading of your child’s BP if they get nervous at the doctor’s office.
    • This will make medical monitoring much easier and trips to the office less frequent. However, the main obstacle to this is that unless your child is adult-size, it may be difficult to find affordable monitors to use at home.
    • Keep in mind that measurement must be accurate. Although BP varies from minute to minute, the averages and trends are important. In people with high BP, even 4-5 mmHg makes a difference when it comes to their health risks from hypertension.
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    Purchase a BP monitor that fits your child. BP cuffs that are too big or too small will give incorrect results. For most kids, an easy way to select a proper size is to measure the distance from the very tip of the shoulder to the elbow crease. Calculate ¾ of that distance. Use a BP cuff with a width that is as close to that number as possible. In cases where the number falls in between sizes, choose the larger of the two. Most cuffs come in widths of:
    • 9 centimeter (3.5 in). (3.5 in.)
    • 12 centimeter (4.7 in). (4.7 in.)
    • 15 centimeter (5.9 in). (6 in.)
    • 18 centimeter (7.1 in). (7 in.) The 18 centimeter (7.1 in) cuff (“large adult”) is usually necessary for older, obese children. Alternatively, you can purchase a “long” 15 cm (adult-size) cuff to accommodate the greater arm circumference.
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    Attach the cuff to your child’s arm. Attach the BP cuff by wrapping it around the upper arm, just above the elbow joint. It should not cover the crease on the inside of the elbow joint. Notice the arrow on the cuff - the cuff should be applied so that the arrow is pointing to the elbow crease.
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    Place a stethoscope under the cuff. Take a manual BP by placing a stethoscope on your child's arm just below the cuff and usually in the elbow crease. This is where one of the major arteries supplying blood to the forearm and hand is located.
    • If you can feel the artery pulsating when gently pressing over the elbow crease, so much the better. The head of the stethoscope should be placed above this pulse, pressing down lightly.
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    Pump up the pressure of the cuff. Be sure that the twist valve at the base of the rubber bulb of the cuff is completely closed. As you inflate the cuff by squeezing the rubber bulb repeatedly, the dial will indicate an increasing pressure.
    • Pump until you reach a pressure likely to be above the child’s BP; around 140 mmHg (the measurement unit) for very young kids, 150-160 for primary school age, and 160-170 for teens.
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    Take a reading of your child’s blood pressure. The cuff pressure momentarily blocks blood flow in the artery. The cuff is then slowly deflated while you listen over the artery.
    • Just as the pressure in the cuff drops below the pressure in the artery, blood begins to flow past the cuff. This initial “spurt” can be easily heard with the stethoscope and is recorded as the systolic BP.
    • As the cuff continues to deflate, the sound eventually disappears. This is recorded as the diastolic BP.
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    Recognize high blood pressure in your child. The range of what is considered a “normal” BP increases throughout childhood. So a normal BP in a 15 year old might be a “high” blood pressure in a 5 year old. The 90th and 95th percentiles are the most useful thresholds for elevated BP in any given child. For example:
    • 90th percentile BP: about 90 of 100 normal children would be expected to have BP below the 90th percentile.
    • 95th percentile: 95 of 100 normal children would be expected to have a BP below that level.
    • BP above the 90th percentile up to the 95th percentile is called “pre-hypertension”. This is the range where there is increased risk of eventually developing hypertension.
    • Likewise, BP above the 95th percentile is considered hypertension. You can look up the percentiles for your child using the same information available to your medical provider, but this can be tedious and you must also know your child’s height percentile.

Part 3
Recognizing Symptoms of Severe High Blood Pressure

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    Monitor any headaches your child feels. Although most children with hypertension have no symptoms, moderate to severe headaches may indicate a hypertensive crisis. These are throbbing and often noted in the early morning or upon awakening.
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    Take your child to the hospital if you notice signs of brain trauma caused by severe blood pressure. Children with brain-related symptoms will usually have blood pressure treated in the hospital, frequently in the intensive care unit. While the blood pressure must be reduced promptly, it is essential to reduce it at a controlled rate, as there is the risk of the brain receiving inadequate blood flow when a very high BP drops too fast.
    • As general rule of thumb, the BP is quickly reduced by about 15-25%, after which it can be further controlled over the following days.
    • Although children can have hypertensive strokes, the more common symptoms caused by the brain's exposure to very high pressures are confusion, unexplained vomiting, double vision, abrupt loss of vision, and seizures.
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    Watch for any signs that your child’s heart is struggling with the severe blood pressure. Chest discomfort or pain, rapid heart beat, difficulty catching the breath or shortness of breath may occur, most often because the heart is struggling to pump blood against such high pressures.
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    Check your child’s urine for blood. Blood in the urine may occur due to kidney injury caused by the hypertension, particularly in those with underlying chronic kidney disorders.
    • It's also important to be aware that sudden and severe hypertension may occur as a result of the development of kidney disease; most of these are of the glomerulonephritis variety (with kidney inflammation).
    • In this case the blood in the urine is from the kidney disease, not the hypertension.

Part 4
Taking Your Child to Get Evaluated

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    Understand that you should take your child to get evaluated by a doctor, but that there is a chance of misdiagnosis. Current pediatric care guidelines recommend the regular measurement of BP during routine check ups beginning at age 3 years. Since most children with high BP will initially have no symptoms, most cases are discovered by routine measurement during doctor visits.
    • Unfortunately, it also can be difficult to obtain an accurate measurement in the office, particularly in younger children. The child's level of activity shortly before measurement, feelings of anxiety (such as anticipating a “shot”), their emotional state and their body temperature will all affect BP.
    • When the initial office BP is compared to several others later in the visit, the first measurement is frequently higher than the rest. With so many potentially confusing factors, it may be easy to explain away or ignore elevated measurements. As a result “real” high blood pressures may be missed.
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    Help prevent misdiagnosis by having your child’s blood pressure checked twice during your visit to the doctor’s office. When an office BP is initially elevated, be sure it is repeated at least twice during that visit. If repeat measurements are normal, hypertension is unlikely. If BP remains high, it should be confirmed by repeating the BP measurements several times during the following few weeks.
    • These should be at least two measurements during each visit and the child should be seated comfortably and quietly for at least 5 minutes before the pressure is taken.
    • Repeated measurements at home can be done if a cuff of appropriate size for your child is available (excessively large or small cuffs will give inaccurate results – see above).


  • There are also automated blood pressure testing devices that you can purchase. However, they may give an inaccurate reading for children.
  • If available, a 24 hour ambulatory blood pressure monitoring study can be obtained to test your child for high blood pressure.


  • Understand that brain and nervous system symptoms can develop because of severely high blood pressure. Brain injury and symptoms may develop not only with very high BP, but also when BP rises quickly.

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Categories: Childhood Health