High Blood Pressure in Children

Diagnosis

To diagnose high blood pressure in children, the doctor performs a physical exam and asks questions about your child’s medical history, family history of hypertension, nutrition, and physical activity level.

Your child’s blood pressure is measured using the correct cuff size, as accuracy depends on proper fit and technique. The measurement should take place in a quiet environment, with your child resting calmly. During one visit, blood pressure may be checked two or more times for accuracy.

A diagnosis of high blood pressure is made only if your child’s blood pressure readings are higher than normal on at least three separate visits.

Once diagnosed, the doctor determines whether the hypertension is primary (no clear cause) or secondary (caused by another condition). Tests that may help identify the cause include:

• Blood tests to check kidney function, electrolytes, and cholesterol and triglyceride levels

• Urinalysis to assess kidney and metabolic health

• Echocardiogram to visualize the heart and blood flow

• Renal ultrasound to evaluate the kidneys

Ambulatory monitoring may also be recommended. This involves your child wearing a device that measures blood pressure throughout the day and night. It helps rule out “white-coat hypertension,” where blood pressure rises due to nervousness during doctor visits.

Treatment

If your child is diagnosed with mild to moderate high blood pressure (stage 1 hypertension), lifestyle changes are usually the first step before medication is considered. If lifestyle changes do not lower blood pressure, or if your child has severe hypertension (stage 2), the doctor may recommend medication.

Common medications include:

• Angiotensin-converting enzyme (ACE) inhibitors, which relax blood vessels by blocking chemicals that cause narrowing

• Angiotensin II receptor blockers (ARBs), which relax blood vessels by blocking the effects of narrowing chemicals

• Calcium channel blockers, which relax the muscles of blood vessels and may slow the heart rate

• Diuretics (water pills), which help the kidneys remove excess sodium and water to reduce blood pressure

The length of medication use depends on your child’s condition. If high blood pressure is caused by obesity, weight loss may reduce or eliminate the need for medicine. Treating other underlying conditions can also help normalize blood pressure. These medications are generally considered safe for children, although long-term effects are still being studied.

Self care

High blood pressure treatment for children is similar to that for adults, focusing on healthy habits and lifestyle changes. Even when medication is needed, these habits can make treatment more effective.

Helpful lifestyle practices include:

• Maintaining a healthy weight or preventing excessive weight gain

• Encouraging a heart-healthy diet rich in fruits, vegetables, whole grains, low-fat dairy, and lean proteins such as fish and beans

• Reducing salt intake — children aged 2 to 3 should have no more than 1,200 mg of sodium daily, and older children should stay below 1,500 mg

• Limiting processed foods and fast food, which are often high in sodium and unhealthy fats

• Ensuring at least 60 minutes of moderate to vigorous physical activity daily

• Limiting screen time to encourage more physical movement

• Involving the whole family in healthy habits to provide motivation and support

Preparing for your appointment

Your child’s blood pressure is usually checked during routine physical exams. Before a blood pressure test, make sure your child has not consumed caffeine or stimulants.

To prepare for the appointment, make a list of:

• Symptoms your child has experienced and when they started

• Family history of high blood pressure, cholesterol issues, heart disease, stroke, or diabetes

• All medications, vitamins, and supplements your child takes, including doses

• Your child’s diet, activity habits, and salt intake

• Questions to ask the doctor

Questions to ask may include:

• What tests will my child need?

• Will my child need medications?

• What foods should my child eat or avoid?

• What is a safe level of physical activity?

• How often should we check my child’s blood pressure?

• Should we monitor blood pressure at home?

• Should my child see a specialist?

• Are there resources or websites you recommend?

What to expect from your doctor

The doctor may ask:

• When was your child’s blood pressure last measured, and what were the readings?

• Was your child born prematurely or underweight?

• Does anyone in your family smoke or have high blood pressure?

Providing accurate information about your child’s lifestyle, family history, and symptoms helps the doctor develop the best plan to manage and treat high blood pressure effectively.