Doctors' Due Diligence: Measuring Kids' Blood Pressure
There have been hints that the obesity epidemic's rise has slowed a bit among certain populations, but for the most part, it continues to dominate American health. One third of children and teenagers are now overweight or obese. And researchers forecast as many as half of our nation's population could be obese — not overweight but obese — by 2030.
With obesity comes a host of health-related problems: diabetes, high blood pressure, heart disease and even certain cancers. Perhaps most worrisome of all, pediatricians report seeing the beginning of these diseases — previously considered problems among adults only — in children as young as 3.
And this is why the American Academy of Pediatrics and federal health officials recommend that doctors routinely screen children for high blood pressure. But diagnosing hypertension in children is more complicated than it is among adults.
"In adults, anything over 140 over 90 is considered abnormal," says family physician Dr. Margaret Riley with the University of Michigan Medical School. Not so for kids.
Normal blood pressure values for children and adolescents are based on age, sex and height. This means doctors need to not only measure a child's blood pressure but also compare it to standardized charts that indicate what's normal for children based on age, sex and height.
"A normal blood pressure for [a 15-year-old boy] is different from that of an 8-year-old girl," Riley says.
She recently published a review of available data in the journal American Family Physician to remind doctors about the importance of not only taking children's blood pressure but also comparing it to standardized tables.
Earlier data show doctors often overlook taking a child's blood pressure during routine visits. Among children eventually diagnosed with high blood pressure, only 26 percent of them had it written in their medical records.
"A physician often will put the blood pressure value in their notes, but they won't address it as high because they won't have recognized it as an abnormal value for that specific child," Riley says, adding, "I think clinicians are used to seeing a number like 100 over 60, and that looks good at first glance, but if you actually look at that for a specific child's age and height, then it may be high for them."
Dr. Reginald Washington, a pediatric cardiologist at Rocky Mountain Hospital for Children, says not diagnosing high blood pressure early can set off a dangerous chain reaction.
"The problem is the body doesn't forgive this; so, if you have high blood pressure or cholesterol as a child, you're setting yourself up for premature problems," says Washington, adding that patients can have strokes in their 20s or 30s if they have high blood pressure that's untreated.
According to one estimate, about 2,000 children and teens suffer strokes every year as a result of hypertension. But the good news, says Washington, is that medication is generally not needed for this age group. Simple lifestyle changes can do the trick. Cutting down on high-fat foods and high-sugar drinks, along with active family outings, can make a big difference, he says. And, because they have higher metabolism, kids have an easier time shedding pounds than adults.
Washington adds that families are often more motivated when their child's health is at stake. Parents should model healthy lifestyles, too, says Riley, by exercising regularly and eating as few processed foods as possible.
STEVE INSKEEP, HOST:
It's Morning Edition from NPR News. Good morning, I'm Steve Inskeep. On this Monday, Your Health, how storytelling can help people with dementia. We'll have that in a moment. First, high blood pressure in children. Every routine doctor's visit should include a blood pressure measurement from the age of 3 onward. But, as NPR's Patti Neighmond reports, doctors don't always do that and often don't recognize when a child's blood pressure is high.
PATTI NEIGHMOND, BYLINE: At the Corner Health Center in Ypsilanti, Michigan, family physician Margaret Riley takes 15-year-old Sara Horn's blood pressure.
DR. MARGARET RILEY: OK, I'm just going to hold your arm up, just rest on my arm. It should feel nice and heavy. That's perfect.
SARAH HORN: It feels like a marshmallow around my arm or something.
NEIGHMOND: Sara's a healthy weight and very active. She plays basketball and runs track. So, the news is good.
RILEY: Very fit, normal blood pressure.
NEIGHMOND: That's not the case for lots of teens who come here. Nationwide, nearly a third of teenagers are overweight or obese, putting them at risk of high blood pressure. When Riley looked at the latest data, she found that among those children who actually had high blood pressure only 26 percent of them had it written in their medical record.
RILEY: The physician often will put the blood pressure value in their notes, but they won't address it if it's high, because they won't have recognized that it's actually an abnormal value for that specific child.
NEIGHMOND: That's because diagnosing high blood pressure in children is more complicated than it is in adults.
RILEY: In adults anything over 140/90 is considered abnormal. In kids, it's different based on the size of their body. So for a 15-year-old boy - a normal blood pressure for him is different from that of an 8-year-old girl.
NEIGHMOND: Which means physicians have to compare a child's blood pressure to national charts of healthy levels for children the same age, gender and height.
RILEY: Yu have to do a lot of steps. I think clinicians are used to seeing number like 100/60 and that looks good on first glance, but if you actually looked for that specific child's age and height, then it may be high for them.
NEIGHMOND: And not diagnosing and treating high blood pressure in kids can set off a dangerous chain reaction. Dr. Reginald Washington is a pediatric cardiologist at Rocky Mountain Hospital for Children.
DR. REGINALD WASHINGTON: The problem is the body doesn't forgive this. So, if you have high blood pressure, high cholesterol or any of those risk factors as a child, you're setting yourself up for what we call premature problems. So patients can have strokes actually in their 20s and 30s if they have high blood pressure that's untreated.
NEIGHMOND: According to one estimate, about 2,000 children and teens suffer strokes every year as a result of hypertension. The good news, says Washington, medication is generally not needed for this age group. Simple lifestyle changes can do the trick.
WASHINGTON: If they have salt on their French fries, we encourage them maybe to eat half as many French fries and try to wean themselves off the salt or the ketchup. If they're a couch potato, we encourage the entire family to go for a walk, for example, once a day.
NEIGHMOND: And families are often more motivated when their child's health is at stake. And because of metabolism, it's easier for kids to lose weight than adults. So if a child is over 3, Dr. Riley says parents should make sure physicians measure blood pressure and compare it to national charts of healthy levels.
RILEY: They can also ask is the blood pressure normal? That would be good. That may cue the physician to check it against the charts as opposed to just brushing past the number.
NEIGHMOND: And parents should model healthy lifestyles too, says Riley, exercising regularly and eating as few processed foods as possible.
Patti Neighmond, NPR News. Transcript provided by NPR, Copyright NPR.