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During the well-child visit of a 3-year-old male, you notice the child has an elevated blood pressure. Looking back in his medical records, he has a slightly elevated BPs documented on three different visits. Describe the workup, differential diagnoses, assessment, and management. How would your plan of care be different if the child were 10 years old?

High blood pressure in younger children is often related to other health conditions, such as heart defects, kidney disease, genetic conditions or hormonal disorders (Flynn et al., 2017).

The correct blood pressure cuff size is important for measuring accurately. It is also important that blood pressure be measured with proper technique, in a quiet environment, with the child resting comfortably. During a single visit, your child’s blood pressure might be measured two or more times for accuracy. For a diagnosis of high blood pressure, your child’s blood pressure must be higher than normal when measured during at least three visits to the doctor, which seems to be the case with this child (Flynn et al., 2017).

If a child is diagnosed with high blood pressure, it’s important to determine whether it’s primary or secondary. These tests might be used to look for another condition that could be causing your child’s high blood pressure:

Blood teststo check your child’s kidney function, electrolytes, and cholesterol and triglyceride levels (lipids)
Urine sample test(urinalysis)
Echocardiogramto create pictures of the heart and blood flow through the heart
Ultrasoundof your child’s kidneys (renal ultrasound)

High blood pressure is treated similarly in children and adults, usually starting with lifestyle changes. Even if your child takes medication for high blood pressure, lifestyle changes can make the medication work better.

Control your child’s weight.If your child is overweight, achieving a healthy weight or maintaining the same weight while getting taller can lower blood pressure.
Give your child a healthy diet.Encourage your child to eat a heart-healthy diet, emphasizing fruits, vegetables, whole grains, low-fat dairy products and lean sources of protein, such as fish and beans, and limiting fat and sugar.
Decrease salt in your child’s diet. Cutting the amount of salt (sodium) in your child’s diet will help lower his or her blood pressure. Children ages 2 to 3 shouldn’t have more than 1,200 milligrams (mg) of sodium a day, and older children shouldn’t have more than 1,500 milligrams (mg) a day (Jacobs et al., 2022).

Secondary hypertension is more common in younger children younger then years of age and children and adolescents with more severe hypertension. Primary hypertension is now considered the most prevalent type of hypertension in childhood, especially in adolescents (Jacobs et al., 2022). Treatment of high BP in children and adolescents is generally tailored to the underlying diagnosis. Lifestyle changes are indicated for all youth with high BP regardless of the underlying diagnosis and include dietary modification (ideally with counseling from a pediatric dietitian) and increased physical activity (Jacobs et al., 2022). Because it is now recognized that some children with white-coat hypertension may progress to having confirmed hypertension, lifestyle measures are important to implement in this group as well. Antihypertensive medications are recommended to lower BP if lifestyle measures fail to improve BP in children and adolescents with primary hypertension (Jacobs et al., 2022).

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