Ask the Pediatrician

Q. When my son had his sports physical, the doctor said he had high blood pressure.  Should I be concerned?

A. Hypertension, or high blood pressure, was once a rare finding in children. But it has become increasingly common as more kids are classified as overweight. Between 2 percent and 5 percent of

children and teens are identified as having hypertension, and the most common cause is related to obesity. In a small percentage of children, an underlying medical problem such as inflammation or scarring of the kidneys, a hormonal imbalance or certain medications may be the cause. 

Hypertension is often without symptoms in children, especially if it has developed gradually. Therefore, children 3 years of age and older should have their blood pressure measured at least annually. Early detection of hypertension and treating with lifestyle changes (exercising regularly, eating healthy foods and avoiding excessive salt) or by using medications can lessen or prevent long-term damage to organs such as the brain, heart and kidneys.

Not every elevated reading of blood pressure is cause for concern, however. Diagnosis of hypertension depends on measurements repeated on several visits that are above the accepted values for age, height and gender. Several factors are important to consider to avoid a false reading:

Appropriate equipment: The most accurate way to measure blood pressure is in the right arm with a blood pressure cuff and stethoscope using a technique known as auscultation. Measurement with an electronic device can lead to falsely elevated blood pressure, especially if measured in the leg.

Appropriate cuff size: A cuff that is too small for your child’s arm can lead to a falsely elevated reading. Cuffs are often marked with a range of arm circumferences. It is important to measure the distance around the middle of the upper right arm.

Adequate resting: Physical activity in the doctor’s office can naturally increase blood pressure, which should be measured after your child has been sitting calmly for five minutes.

“White coat” hypertension: Some children are anxious at a doctor’s office, and blood pressure may be falsely elevated even if they have been sitting quietly. One method to determine whether your child’s elevated blood pressure is true hypertension is to obtain readings at the school nurse’s office, at a local fire department or even at home if you are trained.