Indicators of normal blood pressure in childhood. How to properly measure blood pressure in children

The norms of arterial pressure in children of adults differ. This is important to consider when measuring. Before checking the pressure and directly in the process, it is important to follow certain rules.

Measurement of blood pressure in an adult, especially after 40 years, is a common thing and it seems that today there is no person who does not know how to use. However, sometimes even experienced users have difficulties. For example, the question of how to measure a child's blood pressure at home can raise a lot of questions.

In ordinary life, few people attach great importance to the level of blood pressure (BP) in a child. In fact, this indicator is a very important value. In childhood, there are many diseases accompanied by an increase (hypertension) or a decrease (hypotension) in blood pressure in the vessels. For the diagnosis and control of various pathologies, monitoring (tracking) of the level of blood pressure in children is used.

Significant fluctuations in blood pressure are observed during puberty, especially with VVD (vegetovascular dystonia). Most often, it is during this period that the doctor prescribes monitoring of the performance of the heart.

Before you measure the pressure in a child, you need to decide which apparatus to choose for this. The modern market of medical equipment offers a choice of devices for measuring blood pressure at home with various types of action. These can be such tonometers:

(air is inflated into the cuff manually, the control and reading of the obtained values is carried out by the measuring person);
semi-automatic (manual air injection, automatic detection and display of information on the display);
automatic (all measuring actions are performed by the device).

In addition, other indicators also influence the choice of the type of tonometer, they can be assessed by comparing the mechanical and automatic apparatus. Features of using the first will be as follows:

relatively low cost;
measurement accuracy;
the possibility of replacing parts;
difficulty with independent use without help;
possession of certain skills in measurement techniques;
good hearing and vision for the measurer;
independence of data from inadvertent movement of the hand, conversation, presence of electrical appliances nearby;
no rechargeable batteries or batteries.

Although automatic devices attract with their ease of use, it is still recommended in pediatric practice. If an automatic device is chosen to measure the pressure of a child, then the answer to the question of whether devices for the wrist can be used will be negative.

Method for determining pressure in children

Regardless of which device is chosen for measuring blood pressure, the technique as a whole is the same for everyone and differs little from that in adults. The only important difference is that for children, special children's cuffs must be used, which are superimposed on the shoulder.

Before buying, be sure to check the availability of a suitable cuff size. If the house already has a tonometer, then in the instruction manual or technical data sheet you can find information about the possibility of connecting a cuff for children.

The children's cuff size is determined by the age or circumference of the upper arm, which is measured in the middle of the middle third of its length. The width of the cuff on average should be equal to 2/3 of the circumference of the arm.

The use of an adult cuff in young children is unacceptable.

In older children with a shoulder circumference of 15 cm or more, an adult can be used, but the results must be corrected according to a special table.

Before a direct measurement of blood pressure, the following conditions are met:

the child must be calm for at least 15 minutes (therefore, pressure is measured after waking up or before lunch);
do not take drugs that affect blood pressure (increasing or lowering it);
the measurement is carried out one hour after physical exertion, intense mental activity, a hearty breakfast;
the day before, do not overeat and do not eat foods that can increase blood pressure (chocolate, coffee, tea, cheese, grapes, high-calorie confectionery);
body position should be sitting or lying down (it is better for a child under 2 years old to measure blood pressure when he is lying down);
the shoulder for measurement is placed flush with the line of the heart (you can use a pillow for this);
the room should be quiet, you should not talk during the measurement, there should be no working electrical appliances nearby.

The technique for measuring blood pressure with a mechanical tonometer is as follows.

If the tones are heard before the complete release of air, the diastolic pressure is the value recorded at the beginning of the muting of the tones.

Repeat the measurement three times after 3 minutes. The minimum values or the average value are considered reliable. Ideally, measurements should be taken on both hands.

When determining the level of blood pressure on the legs, the cuff is placed on the lower third of the thigh, and the socket of the phonendoscope is placed in the popliteal fossa. The measurement values on the legs are normally always higher than on the arms.

Norms of pressure in children

In pediatrics, the exact norms of blood pressure have not yet been established. There are many different normative tables and calculation methods by which its values are determined. But, given the specificity of the child's body, it is necessary to compare the data obtained and the individual characteristics of the child:

age;
body mass;
thickness of the subcutaneous fat and muscle layer at the measurement site;
physique features (asthenic, normosthenic or hypersthenic);
character and type of personality;
vegetative tone (vago- or sympathicotonia);
shoulder circumference.

Approximate pressure standards are given in the table.

After 5 years, the value of blood pressure in boys and girls is different. The latter have lower averages. The value of systolic pressure can be calculated using the Vorontsov formula, for this, double the age is added to 90 and the upper pressure norm is obtained, and by adding twice the age and 60, the lower norm is obtained. Possible allowable fluctuations in systolic pressure - 10 - 15 mm Hg. Art, diastolic - 5 - 10 mm Hg. Art.

The technique of how to measure the pressure of a child is easy to learn. Each parent whose child is prescribed to control the level of blood pressure should own such a manipulation. This will allow you to monitor the health of the baby and exclude dangerous diseases.

Measurement of blood pressure in children is not carried out as often as in adults. And the deviation of indicators from the norm may be a sign of other diseases.

Blood is constantly moving throughout the body, supplying nutrients to every cell. The circulatory system consists of vessels and capillaries, veins and arteries. When moving along this highway, blood exerts pressure on the walls of blood vessels. The stronger the expansion of the elastic walls, the higher the performance. Arterial indicators are higher than venous ones. This is where the concept of upper and lower pressure comes from. The measurement is in mm Hg.

A bit of history. The idea of measuring blood pressure has been around for a long time. In the past, physicians could judge the health status of patients by inserting a cannula or catheter directly into a blood vessel. And only at the beginning of the 20th century, the Russian physician Nikolai Sergeevich Korotkov suggested using an indirect, auscultatory method for measuring pressure. For these purposes, a special apparatus is used - a sphygmomanometer (tonometer).

The final scores are based on listening to sound tones. Today, advanced blood pressure monitors are found in almost every home. They consist of a cuff, a pear for pumping air and a valve of a membrane tonometer. In medical institutions, specialists listen to the rhythm with a stethoscope, and modern "home" devices display readings on the screen.

It is not easy to measure the pressure of a child at home. When measuring pressure for small children, there are many nuances: the cuff of a standard device is too large, people who do not have special education do not know the rules for measuring pressure in children and the norms.

The optimal site for measuring blood pressure is the brachial artery. Not everyone knows that pressure is different in different parts of the body.

The pressure in children, as well as in adults, is measured in mmHg.

Arterial pressure (hereinafter, for convenience, blood pressure) is divided into upper and lower. The top is called systolic and occurs when the heart muscle contracts. The lower one is diastolic, its parameters are displayed at the moment of relaxation of the heart muscles.

There is a third very important indicator: pulse pressure. This is the gap between systolic and diastolic pressure. The spread of readings can reach 40-60 mm Hg.

The norm of blood pressure and pulse in children differs from those of an adult. The elasticity of the venous walls, vessels and arteries in a child is much higher than in an adult, because their blood pressure indicators are lower.

Over time, the tone of the vessels in the child increases and the tonometer indicators go up, approaching the "adult" norms during puberty.

The rules for measuring pressure in children correspond to general recommendations: the procedure is carried out in a calm state, the optimal time is in the morning. Before measuring blood pressure at other times of the day, it is recommended to spend at least 10 minutes at rest. One hour before the measurement, do not eat foods containing caffeine. On a full stomach, it is also not recommended to measure blood pressure in children. The child at the time of measuring blood pressure should be in a calm, balanced state. Before the measurement procedure, it would be good to read a fairy tale to the baby, play calm games or just sit quietly.

The line of blood pressure monitors is widely represented in pharmacies. But for children, if there is a need to control pressure, a special cuff is needed. You can buy it at a medical supply store. The use of an adult cuff when measuring blood pressure in a child will lead to a significant distortion of the results.

Cuffs of various widths are provided for different age categories. From 3 cm wide for infants to 10 cm for children in their teens. There are also cuffs for children from 3 to 5 years, from 5 to 8 and from 8 to 10.

The measurement process itself also has its own nuances. The cuff is fixed above the cubital fossa no higher than 3 cm. There should be free space between the cuff and the child’s handle so that you can put your finger in. The phonendoscope is placed on the brachial artery in the area of the elbow bend and air is gradually pumped through the pear. As soon as the sound of the pulse ceases to be heard, the pressure slowly begins to decrease by slightly opening the valve. While air is escaping and blood pressure is measured. Upper pressure is characterized by loud short sounds. As the pressure decreases, the noise decreases. Indicators of the lower pressure are recorded with the disappearance of the sounds of the pulse. Next, the calculation is made on the basis of the obtained readings. It is better to entrust this procedure to specialists. Modern blood pressure monitors display measurement results directly on the display.

Babies under two years of age are measured in the prone position. Children over 2 years old can be measured in a sitting position. The child should sit in a comfortable position without crossing the legs. During the procedure, you can not spin, change position, scream, sigh or talk. The handle in the cuff should lie freely on a solid support at a right angle.

To find out the real readings, the measurement is made several times in a row (at least 3) and the procedure is repeated for several days in a row. The smallest value will be correct.

If the child is healthy, there is no need to conduct constant monitoring, but when he enters the hospital, the doctor must measure blood pressure and monitor the indicators during the entire stay of the small patient in the hospital.

Table of normative indicators of upper and lower pressure by age:

It should be borne in mind that the norm is a relative concept. Blood pressure indicators depend not only on age. But also on the sex, weight and height of the child. If the average indicators for boys and girls from birth to 5 years are equal. Then after the transition of this age limit in boys, the pressure becomes 10 units higher than that of their peers. After reaching 10-11 years, the data are compared again.

Age features leave their mark on blood pressure indicators. During the period of hormonal changes in the body and intensive growth, the pressure in children 12-13 years old can “jump”. Sometimes the indicators reach 120 mm Hg, which corresponds to adult standards. If the child is rapidly "stretched", the pressure in him, most likely, will be reduced.

During puberty, the load on the cardiovascular system increases, and the pressure can deviate both in one direction and in the other. With age, the indicators are normalized if everything is in order with health.

Elevated blood pressure is not only in adults, hypertension in children is quite common. According to statistics, hypertension affects about 14% of preschoolers and about 18% of school-age children. The cause of a persistent increase in blood pressure may be a genetic predisposition and various diseases of the internal organs. So, children under 6 years of age are rarely susceptible to hypertension, but if babies have high blood pressure on an ongoing basis, possible causes of the pathology: systemic kidney disease, aortic disease, congenital lung diseases associated with respiratory failure. The same reasons for the increase in blood pressure in children 6-10 years old. With the entry into puberty, there are more reasons: hormonal background, emotional instability, autonomic dysfunction.

More rare causes of arterial hypertension in children are diseases of the endocrine system.

Elevated blood pressure can be a symptom of serious pathologies that require treatment. Portal hypertension in children is a serious illness resulting from diseases of the liver or heart and blood vessels.

Along with hypertension, children can also suffer from ICP. High intracranial pressure (ICP) can even occur in a newborn baby. But rather it is not a diagnosis, but a symptom of another disease. Intracranial pressure in children under one year is most often manifested as a consequence of birth trauma.

In babies, with an increase in blood pressure or high blood pressure, nose bleeds. Most often it happens with children from 3 to 10 years.

Signs of constantly high blood pressure in a child can be irritability, headaches and dizziness, heart palpitations, pain in the heart.

Treatment of arterial hypertension is carried out by a doctor on the basis of a carefully conducted examination. For 3 weeks, regular pressure measurements are carried out with the results recorded, blood is taken for laboratory tests. Examination is carried out using ultrasound, MRI and other medical equipment.

Self-treatment of hypertension in children is unacceptable. The course of therapy is prescribed by a specialist.

Low blood pressure in children is not uncommon. Often it is not a sign of a disease. Most often, the pressure drops due to overwork, overeating and even stuffiness. But still, a small percentage of children acquire pathological hypotension due to birth injuries, mental stress, a sedentary lifestyle, frequent colds or hormonal changes at the age of 11-12.

With low pressure, children complain of weakness and dizziness. They are prone to tearfulness and mood swings, suffer from sweating and complain of aching pain in the heart after exercise.

If you have signs of hypotension, you should consult your doctor. Doctors usually recommend feasible physical activity, which improves blood circulation. During bouts of weakness, it is recommended to rest and eat some dark chocolate.

The necessary treatment is prescribed by a neurologist. Low blood pressure should not be ignored. This can lead to complications in the form of diabetes, beriberi, anemia, etc.

A systematic deviation of pressure from the norm can lead to serious health consequences, up to a heart attack or stroke, not to mention a wide range of other specific diseases.

Timely treatment under the supervision of a qualified specialist can give good results. Do not forget that the foundation of health is laid in childhood.

Measurement of blood pressure is an important and extremely necessary procedure not only for adults, but also for children. It is carried out by a doctor for violations of the cardiovascular, urinary, respiratory systems and other indications. Children are also encouraged to measure pressure and for preventive purposes.

Instruction

To determine the value of blood pressure

use special children's cuffs. In this case, the result will depend on the correctly selected cuff, more precisely, its width. So,

for a newborn

the required width of the inner chamber of the cuff should be 3 cm, for the chest

child- 5 cm,

for kids

after a year - 8 cm,

for teenagers

and large babies - 10 cm. Using cuffs for adults leads to incorrect data.

Currently, to determine the pressure, there are electronic tonometers. They are divided into automatic and semi-automatic measuring instruments. The first of them are able to pump air into the cuff using a built-in pump,

- with the help of a pear (special supercharger). Quite often in

at home

mechanical tonometers are used. True, working with them requires a certain skill and preparation. The person who takes the measurement must have good hearing in order to be able to accurately pick up the sounds of heart sounds.

Pressure at

child it is better to measure in the morning, immediately after waking up, or no later than 15 minutes after rest. Make sure the hand

child was in a relaxed state and lay palm up at the level

Apply and fasten the cuff on the bare shoulder 2 cm above the elbow, so that one finger can pass between it and the skin. Find the brachial artery in the fold area and, without pressure, attach a phonendoscope to it to determine the pulse.

Use the balloon to inflate the cuff. At the same time, record the moment of disappearance of the sounds of pulse beats. After that, slowly start to decrease pressure by gradually opening the cylinder valve.

pressure manifested by loud beats of the pulse. With a further drop in pressure, the tones in the cuff gradually weaken and soon disappear completely. Moment

termination

pulsation corresponds to the lower pressure reading.

Ideally, arterial

pressure should be determined on both hands, three times with an interval of 3 minutes. The end result is the minimum. Arterial

Useful advice

Remember that the maximum blood pressure in children under one year old is calculated using the formula 76 + 2x, after a year - (90 + 2x) / (60 + x). The minimum pressure is 0.3-0.5 of the previous indicator.

The definition of pressure in children has its own characteristics. The value of blood pressure is influenced by eating shortly before the measurement and physical activity. In addition, the standard sizes of the tonometer cuff may not fit.

You will need

Tonometer with correctly selected cuff.

Instruction

Currently, experts give preference to measuring blood pressure using the Rivaud-Rocci equipment, according to the Korotkov-Yanovsky method. In the process of measuring pressure at

set the device in such a way that the pressure gauge with its zero division is at the level of the artery, at the same time, the artery should be at the same level with the heart. Put the cuff on the shoulder just above the elbow, so that a finger is placed between the shoulder and the cuff. For

appropriate cuff sizes are required, which vary depending on

age

ranging from 3.5 - 7cm to 8.5 - 15cm. Adult cuffs are suitable for children over ten years old.

Pressure

measure in the morning, immediately

sleep or after 15 minutes after the baby has rested. Before starting the study, plant or lay

unbent upper limb, turned palm up so that the hand is on the same level with the heart. At a distance of 3 cm from the elbow, apply a cuff, while clothing should not constrain the limb. After that, in the cubital fossa, feel for

and attach a phonendoscope to this place. Then close the valve on the pear and pump air until the pulse disappears, then slowly release the air, listening through the phonendoscope to heart tones and observing the scale. The first sound tone will mean systolic pressure, and the second - diastolic.

In half an hour

the procedure for measuring blood pressure is not recommended for a child

food, as well as experience physical overexertion. In the room where the procedure is supposed to be carried out, silence must be observed. To determine the pressure in the shortest

use an automatic tonometer. The essence of the procedure is simple, seat the child on a chair with a back, bend your arm at the elbow at an angle of 80 degrees and place it on a flat surface. Put the electronic device on your wrist, then press the button. The tonometer performs all the necessary operations, during which the child should not move and talk.

How to measure the pressure in a child

Blood pressure is the force with which blood presses against the wall of a vessel. This parameter consists of two natural components - systolic and diastolic.

When measured, mechanical vibrations are converted into sound waves, thus forming Korotkoff tones.

Arterial hypertension often begins in early childhood. Timely detection of the first clinical symptoms, the search for the cause, the correct approach to treatment prevent the cardiovascular consequences of high blood pressure. Measuring pressure in children requires not only the basics of medical knowledge and performance techniques, it is primarily an art.

Unlike adults, a child cannot adequately assess the situation, is not critical of his condition, is sometimes inadequate and capricious. The person who starts the manipulation must find an approach to the baby, interest him, calm him down, and have a share of patience.

The child requires a special approach, certain manual skills and serviceable medical equipment that corresponds to age and weight.

First of all, you should specify the indications for measuring blood pressure in babies:

chronic diseases (diseases of the kidneys, endocrine organs, heart defects);
symptoms of arterial hypertension (periodic or persistent headache, palpitations, nosebleeds, fatigue);
children in emergency departments (mandatory component of routine examination and monitoring);
children who are at high risk of cerebrovascular or cardiac catastrophes (obesity, diabetes, coronary artery disease);
all children over the age of 3 years as part of annual preventive examinations;
for a child under three years of age, blood pressure is measured if there are certain indications.

Now we will analyze the main stages of preparation for the procedure. First of all, select the appropriate equipment and check its serviceability. The mechanical blood pressure monitor and stethoscope are the worldwide gold standard due to their high reliability and accuracy. It is undesirable to use an automatic (electronic) device in children due to possible errors.

Algorithm for measuring pressure in children:

select the optimal cuff size based on the fact that the inflatable balloon should completely cover the arm. The width is at least 40% of the circumference of the shoulder. Do not use cuffs that cover the surface of the antecubital fossa, do not tighten too tightly (a finger should pass freely between the balloon and the skin);
reassure the child, and then proceed directly to the measurement;
make sure that the hand is free from clothing (rolling up the sleeve is undesirable, thus the vessels are pinched);
seat the child, put your hand on a table or other support so that the limb is not tense, is at the level of the heart;
apply the cuff so that it occupies the middle third of the shoulder, its lower border should be 2.5 cm above the cubital fossa;
Determine cuff pressure by palpating the radial artery with the index and middle fingers of your free hand while inflating the balloon. When the pulsation disappears, note this pressure on the manometer and add another 30 mmHg;
place the stethoscope membrane directly over the brachial artery (approximately the middle of the antecubital fossa);
deflate the cuff slowly, over about 30 seconds;
remember at what level you heard the first beats (at least two consecutive ones). This is systolic pressure;
continue to deflate the cuff until you can no longer hear the beats. This is diastolic pressure;
deflate the cuff completely and record the readings. After 2 minutes, measure blood pressure on the other arm.

Automatic blood pressure monitors are most often used in children under one year old.

In babies, blood pressure can also be measured in the lower extremities (thigh), while the systolic pressure will be higher than in the arms. This approach is useful for detecting certain heart defects (coarctation of the aorta).

At what age can children measure blood pressure?

From the age of three, blood pressure is measured once a year during a routine medical examination.

Here we will talk about the Korotkov tones, which should be guided by when measuring:

tone 1. The appearance of a clear sound in the stethoscope, which correlates with systolic pressure;
tone 2. Follows the first, but has no diagnostic value, this sound is quieter and softer;
tone 3. The sound begins to gradually increase, it is not clinically significant;
tone 4. The sound becomes muffled and disappears. This is diastolic pressure.

When measuring blood pressure according to the Korotkov method (mechanical tonometer), errors can be observed with an incorrectly selected cuff. So, if it is more than due, blood pressure is falsely low. If the cuff is narrow, the pressure will be too high.

Sound artifacts may be heard if the child moves or cries during the measurement.

What blood pressure is considered normal?

When working with children, it cannot be said that some BP numbers are a universal norm. Doctors use special tables and graphs in which pressure is distributed by age and gender. Such values are called percentiles.

Blood pressure is considered elevated if it is more than 95 percentile, low if it is less than 5. This may seem like a rather complicated and incomprehensible approach, for ease and clarity, a table of normal indicators is presented.

Table 1. Girls:

Table 2. Boys:

A child whose blood pressure is greater than the 95th percentile should visit the pediatrician at least three times and have their blood pressure checked. With persistently high numbers, a diagnosis of arterial hypertension is made, and therapy is selected.

Use of an adult cuff is allowed for children over 10 years old. The difficulty starts with the fact that you will not be able to place it properly on the shoulder (too small circle).

Microlife mechanical blood pressure monitor

It is important to understand that the indicators will be unreliable, the selection of drug therapy (dosage), control of effectiveness may be incorrect. If the cuff is larger, then the blood pressure will be falsely low.

In a hopeless situation, you can measure blood pressure on the thigh, this partially solves the issue of discrepancy between the circumference and brings the indicators closer to more or less reliable. In this case, it is important to remember that on the leg, blood pressure is 15-20 mm Hg. higher than on the hand.

As mentioned above, a large cuff lowers pressure.

There is a technique by which you can correct the indicators.

When measuring blood pressure with an adult tonometer, it is necessary to add 10 mm Hg to the obtained figures when measuring on the arm and 5 mm Hg when performing manipulations on the thigh.

It is important to remember that the above method is not reliable, it gives large errors.

If your child needs a blood pressure measurement, please contact a doctor or trained health care provider who can recommend the appropriate equipment.

On the norms of pressure and signs of hypertension in children video:

Remember that children are not small adults, they require a special approach, have unique anatomical and functional features.

One of the indicators of the work of the heart is the level of blood pressure. There are rules for every age. A change in this indicator indicates trouble in the body and requires treatment.

The heart pumps blood constantly. This work ensures the uninterrupted supply of nutrients and oxygen to the internal organs. Blood, moving through the vessels, causes their tension. This process is called blood pressure (BP).

The diameter and size of blood vessels change with age. This feature is associated with a decrease in the plasticity and tone of arteries and veins. These indicators affect the initial norms of blood pressure in different age groups. There are no pronounced differences in this parameter among children of the same age, boys and girls.

This indicator is quite stable and should not fluctuate greatly during the day. Any deviations from the norm require attention and the establishment of the cause that could cause such a violation. Frequent fluctuations in blood pressure can lead to various diseases of the heart and blood vessels.

The indicator is measured in millimeters of mercury (mm Hg). Usually, only two indicators of blood pressure are analyzed - systolic and diastolic. In some cases, the pulse is also recorded.

Normal blood pressure indicators are summarized in various tables, which are developed taking into account mass examinations of babies of different ages. To compile them, a large number of children of the same sex and age are surveyed. Such centile tables allow you to determine the norms of this indicator in each specific age group. Measure blood pressure on the brachial artery.

During the day, this indicator of the work of the heart may change. In hot weather, during intense physical exertion or after a strong psycho-emotional experience, blood pressure figures can significantly deviate from the norm.

To assess the work of the heart, doctors use several indicators that can be calculated, knowing the initial level of blood pressure in the baby. The analysis of these parameters helps cardiologists to determine the disease and even determine how severe the disease of the heart or blood vessels can be.

Why it is important to know your child's blood pressure can be found in the following video.

There are several types of blood pressure:

Systolic. Shows the work of the heart during the period of active contraction. When listening to tones during pressure measurement, it appears as the first sound that is heard in the phonendoscope.

diastolic. Characterizes the work of the heart during diastole - relaxation. When measuring pressure, it appears as the last, clearly distinguishable sound.

Cardiac. Arithmetic difference between systolic and diastolic pressure. In the aggregate of other indicators, it gives an idea of the work of the heart, as well as how well it pushes blood through the vessels.

Algorithm and measurement technique

In order to determine the pressure in a child, you need to use a special device - a tonometer. The modern pharmaceutical industry offers a huge range of such measuring devices. They can be fully automatic or semi-automatic.

In order to measure the pressure in a child at home, use the following algorithm of actions:

Measure the indicator in the morning or before bedtime.

Starting position - sitting. The legs should be bent at the knees, the feet should be approximately at the same level. In newborns and infants, pressure is measured lying down.

Place the cuff 1-2 cm above the cubital fossa. Between the baby's skin and the cuff, the mother's finger should pass freely. Do not try to put the cuff on your arm too tight! Strong pressure can cause the child to be frightened and sore when measured.

For an automatic device - just press the power button. The device will automatically start measuring.

If the device is not automatic, then first put the phonendoscope in the region of the cubital fossa. The skin in this place is very thin, and the pulse is perfectly heard here. Inflate the bulb of the tonometer until the pulsation stops completely.

Turn off the valve on the pear and slowly release the air. The appearance of the first well-audible sound is systolic pressure or upper. Listen to the pulse until the sound disappears completely. The last of them is an indicator of diastolic pressure. It is also called the bottom.

Gently release all the air from the bulb and remove the cuff from the baby's arm.

Measurement of blood pressure is best done when the baby is calm. You can do this after waking up or before going to bed. This indicator should not be measured immediately after eating or active movements. In this case, an increased level of pressure will not be an accurate indicator of the work of the heart in normal mode.

Keep a diary in which all indicators of blood pressure measurements in a child will be entered. Record systolic and diastolic pressure. If the tonometer is automatic and provides for counting the pulse, then also record this indicator in the diary. Keeping such records will help the attending physician or cardiologist to assess the work of the heart and blood vessels more qualitatively.

To get a more accurate result, it is better to measure blood pressure three times. Before each subsequent determination of the indicator, a 5-7 minute break is made. The obtained values are summarized and the average is calculated. Calculations are carried out separately for systolic and diastolic pressure. The arithmetic mean is the most accurate indicator.

Is it possible to measure with an adult blood pressure monitor?

For kids of different ages, there are their own children's cuffs. They are smaller in diameter and wrap around the child's hand well.

Adult cuffs for measurements are not recommended. Usually they are too large for babies and do not allow you to get a reliable result.

Measurement with adult cuffs will only cause severe pain in the baby, but will not be informative. For teenagers from 14 years old, teenage cuffs are used. They can also be used in younger children. If the child is too obese or has diabetes, then the teen cuff can be used from the age of 8.

The thickness of the inner chamber of the cuff in babies of the first days after birth should be three centimeters, and in children under one year old - five. During active movements or crying, the child may have high blood pressure. It is better to measure indicators during complete calm.

Table by age

Blood pressure readings change as the child grows. At preschool age, given the small diameter of blood vessels and excellent elasticity, this figure is relatively lower than in adolescents.

The norms of blood pressure in children at different ages are presented in the following table:

These figures are indicative. Each identified single deviation from the norm does not yet indicate the presence of a heart or vascular disease in the baby. Additional testing is required to establish a diagnosis. not just measuring blood pressure.

In children from 7 years old, there is a slight increase in blood pressure. This is due to the increasing mental stress at school. A new environment and stress lead to an increase in the initially normal level of this indicator.

This condition cannot be interpreted as a disease. Usually it passes after a while, after the child adapts to new conditions.

What causes the rise?

There are many reasons for high blood pressure. Every child has their own. In some cases, high blood pressure may be the result of exposure to several provoking causes at the same time. This indicator changes not only with heart disease.

A persistent increase in blood pressure is called arterial hypertension.

The following reasons most often lead to the appearance of this condition in a child:

Damage to the renal vessels leading to the development of secondary renal hypertension. They can be congenital or acquired as a result of various kidney diseases. Usually cause an increase in systolic blood pressure. Difficult to treat.

Kidney diseases. These include: traumatic injuries, oncological pathologies, violations of the anatomical structure, dysplasia. Cause mainly an increase in diastolic pressure.

Heart diseases: defects in the structure of the valvular heart apparatus, congenital malformations, rhythm disturbances and myocardial conduction.

Endocrine pathologies. Crohn's disease or parathyroid tumors. As a result of these diseases, metabolic disorders occur. Biologically active substances and hormones begin to be produced in large quantities, which lead to a strong narrowing of blood vessels. This condition causes an increase in blood pressure.

Long-term use of pills and medicines. Hormonal drugs and sympathomimetics often lead to the development of arterial hypertension.

Bad habits. Adolescents who start smoking often suffer from hypertension.

G enetic predisposition. In families where one of the parents has high blood pressure, the risk of having a child with arterial hypertension is 25%.

An increase in pressure happens not only with pathologies. In some cases, it rises after normal life situations. For example, severe stress or overwork at school can cause high blood pressure. In boys from the age of 11, the level of blood pressure begins to exceed the corresponding indicators of girls of the same age by 4-5 mm. rt. Art.

A child who plays sports or physical activity irregularly also has a high risk of developing arterial hypertension. Running too fast or exercising too hard can cause your child to develop high blood pressure. This is due to the weak tone of the blood vessels.

High blood pressure can manifest itself in different ways. Usually the child feels a headache and weakness. A student suffering from arterial hypertension finds it rather difficult to concentrate on a subject at school. Already after 2-3 lessons, he feels overwhelmed and unable to perceive the educational material.

Another characteristic symptom of high blood pressure is dizziness or flies before the eyes. This state does not last long. The dizziness usually goes away after a few minutes. With a persistent increase in blood pressure, it may not disappear within a couple of hours.

Very high blood pressure can even cause vomiting. Usually it is short-term and does not depend on food intake. This symptom is rare, but requires urgent medical attention. When vomiting occurs, not only high blood pressure should be suspected, but also an increase in intracranial pressure.

What causes the decline?

Low blood pressure is called arterial hypotension. This condition occurs in infants and toddlers at different ages. As the child grows, the pressure level should increase. If this does not happen, then this is already a good reason to see a doctor.

The most common causes that cause arterial hypotension are as follows:

Diseases of the thyroid gland. Decreased levels of thyroid hormones cause impaired vascular tone. This condition leads to the development of a decrease in pressure. Only treatment of the thyroid gland contributes to the normalization of the condition.

Trauma and tumors of the brain. The circulatory center is located in the cortex. When it is damaged, there is a violation of coordination in the work and tone of blood vessels. Such conditions can lead to the development of a persistent decrease in pressure.

Diseases of the endocrine system. Metabolic disorders lead to changes in the elasticity and tone of the arteries.

Exhaustion after severe and frequent respiratory infections.

Strong stress.

Malnutrition and malnutrition.

A decrease in blood pressure in a child is an occasion to examine the baby more carefully. Many chronic diseases, which can be very dangerous, cause persistent hypotension. It is possible to normalize pressure in such situations only with the correct treatment of the underlying disease that caused this condition.

Hypotension is also not an independent disease. It is just a symptom found in various conditions. Even banal stress or severe overwork can cause a decrease in pressure in a baby.

Arterial hypotension is also common in adolescence in girls who begin to copy adult behavior. Excessive addiction to thinness and harmony can cause anorexia in a girl. This condition is often accompanied by a persistent decrease in blood pressure, which is difficult to normalize even with medication.

Reduced pressure is manifested by a violation of general well-being. Usually the child becomes more lethargic. Students cannot concentrate while learning. Toddlers of an earlier age begin to act up, become slower and more inhibited. With a pronounced decrease in blood pressure, a headache may appear.

How to lower the pressure?

To normalize blood pressure, several different methods are used. In the presence of persistent hypertension, doctors prescribe a whole range of therapeutic methods. Such a system allows you to reduce pressure and keep it at the proper level for many years.

To eliminate arterial hypertension, apply:

Correct daily routine. Getting up in the morning at the same time helps to normalize the tone of blood vessels and normalize pressure.

Complete sleep. At night, the baby should sleep at least 8-9 hours. Toddlers of preschool age should also rest during the day. Usually 2-3 hours are allotted for daytime sleep.

Complete nutrition with a reduced amount of salt. It contains sodium. When taken in large quantities, it can cause severe spasm and narrowing of blood vessels. This leads to an increase in pressure. Limiting salt and all canned and pickled foods has a beneficial effect on blood pressure levels.

Taking medications. Diuretics, antispasmodics, ACE inhibitors, and calcium channel blockers can be used. The selection of the drug is made taking into account the underlying disease that caused the increase in pressure. Potassium preparations are used for kidney diseases.

Optimal training regime. Loads in sports sections or when playing sports for a child with arterial hypertension should be strictly dosed and not excessive. Overwork should not be allowed. This condition quite often leads to an increase in pressure.

Reducing stress and psycho-emotional stress. Neurotic conditions often lead to the development of arterial hypertension in children. Large loads at school, with which the child does not cope well, also contribute to increased pressure.

Walks in the open air. A large amount of oxygen has a positive effect on the tone of blood vessels and eliminates spasms. Walking at a moderate pace for at least an hour a day helps to normalize blood pressure.

Getting rid of bad habits. Smoking in adolescence and the use of low-alcohol alcoholic beverages contributes to the development of arterial hypertension, and later even hypertension.

How to increase pressure?

Before taking measures to increase blood pressure, you should show the child to a cardiologist. Often, behind the mask of arterial hypotension, many diseases that require prior treatment are hidden. Without eliminating the cause that caused a persistent decrease in pressure, it will not be possible to normalize it.

To manage the symptoms of hypotension, you can use the following methods:

When choosing them, preference should be given to the individual characteristics of the child and his interests should be taken into account. To normalize blood pressure, almost all types of physical activity are suitable. They should be performed regularly.

Complete nutrition according to age. Insufficient intake of all the necessary elements and vitamins leads to a child lagging behind in physical development, as well as a decrease in the tone of blood vessels. The baby should eat at least 5-6 times a day.

Strengthening immunity. Frequent colds and infectious diseases lead to persistent hypotension. Regular walks in the fresh air and good nutrition will help the child strengthen the immune system and get sick less.

Strong tea or cocoa. For teenagers - coffee. With an attack of a strong decrease in pressure, these drinks should be offered to the child. They contain caffeine, which increases blood pressure. If a child has an arrhythmia, then coffee is contraindicated for him.

The use of adaptogens. You can use eleutherococcus, lemongrass infusion or ginseng. The use of these medicines may cause an allergic reaction. Before use, the child should be shown to the doctor to exclude possible contraindications.

Massage. It is usually carried out in a stimulating mode. Helps to normalize vascular tone. Appointed by the course, 10-12 procedures 2 times a year.

Various physiotherapy techniques. A contrast shower or underwater massage are great. These methods normalize the work of the organs of the cardiovascular and nervous system. Usually, after 8-12 sessions, blood pressure normalizes.

Caffeine-based drugs. Issued by a cardiologist. Do not apply to babies suffering from cardiac arrhythmias. Such drugs should not be used for arrhythmias.

Who to contact?

If the measurement of blood pressure in a child revealed a deviation from the norm, then it should be shown to a pediatrician or cardiologist. Any changes in this important indicator may indicate trouble in the work of the heart or internal organs.

Doctors may prescribe additional examinations for the examination. These include the Holter measurement of blood pressure. With the help of a special apparatus, which is placed on the child, the parameters of the heart are monitored for a full day. This study allows you to more accurately establish the diagnosis and identify the cause of deviations in blood pressure.

Violations in the work of the heart can have very dangerous consequences. Control of blood pressure levels is a must in children at any age. This will allow you to identify the first symptoms in time, and start treatment in a timely manner.

Measurement of blood pressure is a very important procedure that must be carried out with frequent intervals not only for adults, but also for children. High or low blood pressure can indicate serious malfunctions in the body, and if you miss these deviations, this can lead to serious pathologies. Blood pressure depends on many factors, but primarily on the tone and elasticity of blood vessels, as well as on the force of contraction of the heart.

Normal blood pressure in a child

Children have lower blood pressure than adults. This is due to the fact that children have more elastic vessels. However, the older the child, the higher his pressure becomes, due to the fact that with age, the vessels lose their elasticity.

The level of blood pressure in a child primarily depends on weight, height and age. The average pressure in children is calculated by the formula:

Infant systolic (upper) pressure: 76+2x, where x is age in months;
in older children: 90+2x, where is the number of years.
The level of diastolic (lower) pressure in infants is from 1/2 to 3/2 of the systolic pressure;
in older children: 60+x, where x is the number of years.

Blood pressure in children

Age

Systolic BP
mmHg.

Diastolic BP
mmHg.

0-12 months

Blood pressure fluctuations are influenced by many external and internal factors: time of day, diet, strong emotions, pain, weather, atmospheric pressure, heredity, the presence of chronic diseases.

In children, persistent arterial hypertension is less common than in adults and is most often secondary, or symptomatic, that is, caused by damage to internal organs: the brain, heart, kidneys. An increase in blood pressure can occur due to narrowing of the isthmus of the aorta (coarctation of the aorta), and the pressure in the legs will be significantly reduced.

Risk factors for developing hypertension in children:

heredity;
the presence of chronic diseases;
constant emotional stress, frequent stressful situations;
obesity;
excessive consumption of table salt;
diabetes mellitus and predisposition to it;
personality traits of the child.

Symptoms of arterial hypertension in children:

nosebleeds;
headache;
dizziness;
flashing "flies" before the eyes;
visual impairment;
weakness and lethargy;
nausea and vomiting;
drowsiness.

Rules for measuring blood pressure in children

It is preferable to measure blood pressure at home with an automatic or semi-automatic tonometer, the use of which will greatly facilitate the procedure and eliminate the influence of the human factor. It is important to choose the right cuff, as measuring with an adult cuff will give incorrect results. The dimensions of the cuff depend on the age of the child and are: in infants - 3.5x7 cm; from 1 to 2 years - 4.5x9 cm; from 2 to 4 years - 5.5x11 cm; from 4 to 7 years - 6.5x13 cm; from 7 to 10 years old - 8.5x15 cm; from 10 and older - an adult cuff will do.

It is best to measure the pressure in the morning, 15-20 minutes after waking up or resting. The child should take a comfortable position (lying or sitting), be calm and relaxed. The hand on which the measurement will be made should be located at the level of the heart and be free from clothing. Next, a cuff is fixed on the arm 2-3 centimeters above the elbow bend, and, depending on the type of device, measurements begin. If this is an automatic blood pressure monitor, then just press the power button and the air will automatically be pumped into the cuff and after a few seconds the result will be displayed on the display of the device. In a semi-automatic tonometer, air is injected and bled using a pear. For a more reliable result, you should measure the pressure 3 times with an interval of 2-4 minutes and calculate the average value.

Suitable blood pressure monitors for measurement

For a child, it is not necessary to buy a separate blood pressure monitor, it is enough to purchase a children's cuff. When buying a tonometer, pay attention to its functionality. For a large family, it is worth choosing a tonometer with a measurement memory for two users with registration of the measurement time. This will help to track the slightest deviations of pressure from noma. For hypertensive patients, the functions of monitoring morning hypertension and an indicator of high blood pressure will not be superfluous.

Tonometer Omron M1 Eco
Approximate price: 1,700 rubles

semi-automatic tonometer;
memory for 42 results + registration of date and time;
indicators of arrhythmia and high blood pressure;
calculation of the average value of arterial pressure from the last three results;
large display.

Tonometer Omron M10-IT
Approximate price: 8 900 rubles

automatic tonometer;
memory for 2 users for 84 measurements + guest mode;
indicators of movement, arrhythmia, high blood pressure;
the presence of a function for calculating the average value of blood pressure from three measurements;
it is possible to connect to a computer.

How to measure blood pressure in a child?

The prevalence of arterial hypertension among newborns is 2.3 - 3%. It should be noted that arterial hypertension among newborns is almost always secondary - due to kidney disease. There have been cases of arterial hypertension in newborns as a result of the mother's illness, her taking medications (steroids).

The best way to measure blood pressure in newborns is to measure blood pressure with a catheter in the umbilical or radial arteries. The blood pressure data in a child in the prone position will always be lower than in the supine position. It should also be noted that in newborns it is more optimal to measure blood pressure with devices operating on the oscillometric principle - they are designed for intermittent measurement of blood pressure for a long time.

BP values in newborns depend on body weight, gestational and post-conceptual age. On average, blood pressure in newborns is 72/55 mm Hg. In premature babies, this figure is slightly lower. Mean BP is usually in the range of 30-55 mmHg. DBP - 15-30 mm Hg. Art. In the first five days of life, mean blood pressure in healthy full-term babies increases by 2.2–2.7 mm Hg. per day. DBP - by 1.6 - 2 mm Hg. Girls have slightly lower scores. For the postpartum period, hypertensive indicators will be considered - more than 90/60 mm Hg. in full-term children and more than 80/50 mm Hg. in premature babies.

Causes of arterial hypertension in newborns:

Renovascular disorders
Bronchopulmonary dysplasia
Low Apgar scores at birth
Anomalies of the ureters
Closure of the anterior abdominal wall
Hemorrhage in the adrenal gland
long-term parenteral nutrition
Extracorporeal membrane oxygenation
subdural hematoma
Coarcation of the aorta
Congenital adrenal hyperplasia
Other causes (tumors, kidney disease)

Clinically noted irritability of the child, shortness of breath, unmotivated crying, delay in weight gain, growth, convulsions. The development of chronic heart failure is often observed.

It should be noted that with adequate treatment of hypertension, stabilization of the condition is observed. Be sure to determine serum electrolytes, creatine, residual nitrogen, urinalysis. Determine the concentration of renin. Often resort to endocrinological research, sonography, ultrasound, angiography. Treatment is strictly individual, with the use of medications. The prognosis depends on the severity of the disease.

Read also:

Hypertension in children

Hypertension in children: treatment and symptoms

Arterial hypertension, hypertension in children is a persistent increase in blood pressure above the 95th centile of the blood pressure distribution scale for a specific age, sex, weight and body length of a child. Normal blood pressure is considered to be the values of systolic and diastolic blood pressure that do not go beyond the 10th and 90th centiles. High normal blood pressure, or borderline hypertension, is defined as blood pressure between the 90th and 95th centiles. Children with such AD constitute a risk group and require dispensary observation.

Arterial hypertension in adults is one of the most common cardiovascular diseases. Arterial hypertension affects up to 1/3 of the population of Russia, while up to 40% of them do not know about it and, therefore, do not receive treatment. Therefore, such serious complications of arterial hypertension as myocardial infarction or stroke occur quite suddenly.

Population studies of blood pressure in children in our country have not been conducted. The prevalence of arterial hypertension in children, according to different authors, ranges from 1% to 14%, among schoolchildren - 12-18%. In children of the first year of life, as well as early and preschool age, arterial hypertension develops extremely rarely and in most cases has a secondary symptomatic character. The most predisposed to the development of arterial hypertension are children of prepubertal and pubertal age, which is largely determined by autonomic dysfunctions characteristic of these periods of childhood.

Causes of hypertension in children

In most cases, persistent arterial hypertension in children is secondary. The structure of the causes of arterial hypertension has distinct age-related features; at the same time, kidney pathology predominates (Table 128).

Table 128 The most common causes of arterial hypertension in children, depending on age

Age group

Intracranial hypertension in the newborn

Intracranial hypertension (from Latin hyper - increased, tensio - pressure, tension) is an increase in CSF pressure. In the brain there are so-called. The ventricles are cavities filled with fluid - cerebrospinal fluid. Liquor, formed in the ventricles of the brain, flows through the system of communicating ventricles into the canal of the spinal cord. If for some reason the outflow is disturbed, the cerebrospinal fluid lingers in the ventricles of the brain, and the pressure rises. This is how intracranial hypertension develops.

What could be the reason for the violation of the outflow of cerebrospinal fluid? The most common causes of intracranial hypertension in newborns are: intrauterine infections, anomalies in the structure of the brain, injuries of the cervical spine during childbirth. Infections and lack of oxygen (hypoxia) in the prenatal period can lead to increased production of cerebrospinal fluid, and not only to outflow disorders, which also contributes to an increase in pressure.

How does intracranial hypertension manifest itself? In newborns, an increase in intracranial pressure manifests itself in the form of neurological symptoms: trembling of the chin, limbs at rest or when crying, restless behavior of the child, poor sleep, increased appetite, crying during feeding, profuse or frequent regurgitation, nystagmus (involuntary horizontal eye movements), too bright reflexes of the newborn. Characteristic is also an increase in the tone of the extensor muscles (sometimes vice versa), which is manifested by tilting the head back during crying or even at rest; the legs and arms of the baby are difficult to bend (or unbend) due to increased resistance.

What to do if the baby has intracranial hypertension? First of all, you should consult a doctor - a pediatrician or a neurologist. He will examine the baby, prescribe the appropriate examination and treatment. The diagnosis of "symptom of intracranial hypertension" is made on the basis of the clinical picture and examination, first of all - ultrasound examination of the brain. Ultrasound reveals ventricular dilatation accompanying hypertension.

Treatment of a child should be prescribed by a neurologist or neonatologist if the baby is still suffering from this disease in the maternity hospital. Treatment includes drugs that improve cerebral circulation, diuretics, sedatives and sedatives.

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When measuring the pulse, the child should be at rest (lie down). If he ran before that, you need to give him time to calm down. Turn off the bright light music, TV. Next, you need to feel for a pulse on the radial artery (immediately behind the wrist, slightly inside the forearm). You can feel the pulse in the neck or in the inguinal fold on the inner surface of the thigh. You can use a phonendoscope if you have one. For measurement accuracy, the pulse must be counted for a minute (and not 15 or 30 seconds with multiplying the result by 4 or 2).

How to measure blood pressure

This question, as a rule, arises when the child has long passed the period of infancy, but there are exceptions. Measurement of blood pressure is a medical procedure, and any person, and especially a child, always reacts to this manipulation by increasing it (there is a common term “white coat hypertension”). Therefore, the correct measurement in the usual conditions, at the same time (in the morning, after school, in the evening) will be more informative than in the doctor's office. If there are complaints, for example, headaches, it is recommended to keep a diary indicating the time of their occurrence, intensity, nature, duration and magnitude of blood pressure at the beginning, during the greatest severity and after the cessation of pain.

Do not use electronic blood pressure monitors - in most cases they give incorrect results.

In practice, very often in a child hospitalized for examination for arterial hypertension, determined at home by an electronic tonometer, it is not confirmed. The most accurate results are given by mercury manometers, but they are fragile, and mercury is toxic. It is usually quite enough to have a simple serviceable mechanical tonometer.

It is necessary to follow the basic rules for measuring blood pressure. To obtain the most accurate result, it should be done in silence, without strong light and at normal room temperature. During the measurement, the child should be calm - this will help to avoid an overestimated pressure value due to anxiety associated with the study.

Pain, feeling unwell, nausea, stress, bladder fullness, recent food intake and physical activity, certain medications, and smoking may overestimate readings. Clothing interferes with cuff fixation, pressure measurement, and listening to tones.

If the pressure is measured while sitting, you need to choose the right height of the table. It should be such that the middle point of the cuff is at the level of the heart. You need to sit straight, placing your feet on the floor and leaning back in a chair. This will help to avoid an increase in blood pressure due to isometric muscle contraction.

It is best to let the child lie down or sit in a relaxed position for 10 minutes with the cuff on the right arm to stabilize the measured parameters. You can't talk during the procedure.

If the measurement is taken in the supine position, the midpoint of the cuff should be at mid-chest height. To regulate the level, you can use a pillow, books. The rubber part of the cuff should cover the arm at least 80% of its circumference. Using a cuff that is too narrow or too short is a serious (and, unfortunately, common) mistake and will cause the meter to read too high.

The middle of the rubber chamber of the cuff should be against the artery passing along the inner surface of the shoulder (it is recommended to find it by touch). The lower edge of the cuff should be 2.5 cm above the antecubital fossa.

You don't need to cuff your clothes. If clothing is thick or restricts movement, it must be removed. Rolling up the sleeve in this case can compress the vessels and distort the result.

Immediately before the measurement, you need to attach a phonendoscope to the projection of the artery located in the elbow bend (it is recommended to first probe its location). The cuff must be inflated quickly and to a value known to be larger than expected. Slow inflation blocks the movement of venous blood in the arm and can lead to pain, muffled or distorted tones. Then open the valve and slowly deflate the cuff at a rate of 2 mmHg per second until pulse sounds (Korotkoff sounds) appear. The readings of the tonometer at this moment will display the maximum (systolic) pressure. Continue to decrease the pressure at a rate of 2 mmHg per heartbeat. The disappearance of tones will correspond to the minimum (diastolic) pressure. Deflate the cuff completely.

The accuracy of pressure determination cannot be numerically higher than the rate of pressure decrease in the cuff. This means that a decrease in pressure at a rate of 10 mmHg per second provides an error of 10 mmHg. If one heartbeat is missed, the error will be 20 mmHg. For greater accuracy, the measurement is carried out three times with an interval of 1-2 minutes, which is necessary to restore venous outflow. The final result is the average of the three measurements. For example, if the readings of three measurements were: 120/70, 110/60 and 115/65 mm Hg. Art., then the result can be considered 115/65 mm Hg. Art.

To what extent should the pressure be considered normal? There are tables that determine the norms of blood pressure depending on age, height and gender. The value of blood pressure is influenced by weight (blood pressure is higher in children with obesity) and the predominant type of autonomic regulation.

Changes in blood pressure in a child

In accordance with the recommendations of the experts of the All-Russian Scientific Society of Cardiology and the Association of Pediatric Cardiologists of Russia (Moscow, 2003), criteria for assessing the normal level of blood pressure (BP) and arterial hypertension (AH) have been adopted.

normal blood pressure- systolic (SBP) and diastolic (DBP) blood pressure, the level of which is in the range from the 10th to the 90th centile of the blood pressure distribution curve in the population for the corresponding age, sex and body length.
High normal blood pressure- SBP and DBP, the level of which is in the range from the 90th to the 95th centile of the BP distribution curve in the population for the corresponding age, sex and body length.
Arterial hypertension A condition in which the mean SBP and/or DBP calculated from three separate measurements is equal to or greater than the 95th centile of the BP distribution curve in the population for the appropriate age, sex and body length.
Labile arterial hypertension- unstable increase in blood pressure, when an elevated blood pressure level is recorded intermittently (with dynamic observation). This condition is usually observed with neurocirculatory dysfunction (F45).
Primary (essential) arterial hypertension(PO, synonym: hypertension) is a chronic disease, the main manifestation of which is hypertension syndrome, not associated with the presence of pathological processes in which an increase in blood pressure is due to specific causes (symptomatic hypertension).
Secondary (symptomatic) arterial hypertension- increased blood pressure due to the presence of pathological processes in various organs and systems.

The most common causes of secondary hypertension in different age periods:

up to 1 year - thrombosis of the renal arteries or veins, stenosis of the renal arteries, congenital anomalies of the kidneys, coarctation of the aorta;
1-6 years - renal artery stenosis, kidney disease, Wilms' tumor, neuroblastoma, aortic coarctation, Itsenko-Cushing's disease, pheochromocytoma, polyarteritis nodosa;
7-12 years - kidney disease, renovascular pathology (neurofibromatosis, external compression, vasculitis, etc.), aortic coarctation, essential hypertension (PA), Itsenko-Cushing's disease and Cushing's syndrome, pheochromocytoma, polyarteritis nodosa;
12-18 years old - essential hypertension, kidney disease, renovascular pathology (neurofibromatosis, external compression, vasculitis, etc.), pheochromocytoma, Itsenko-Cushing's syndrome, polyarteritis nodosa.
Hypotension is a condition in which the mean level of SBP and/or DBP, calculated from three separate measurements, is equal to or below the 5th centile of the BP distribution curve in the population for the corresponding age, sex and body length.

Features of examination of children with arterial hypertension

Stages of assessing the level of blood pressure for the diagnosis of arterial hypertension:

study of pedigree;
determination according to special centile tables of body length corresponding to the sex and age of the patient (Appendix 6);
calculation of average SBP and DBP values based on three measurements of blood pressure, carried out with an interval between them of 2-3 minutes;
comparison of the average values of SBP and DBP of the patient, obtained from the results of three measurements of blood pressure during one visit, with the 90th and 95th centiles of blood pressure, corresponding to the sex, age and centile of the patient's body length
comparison of the mean values of SBP and DBP recorded in the patient at three visits with an interval between them of 10-14 days, with the 90th and 95th centiles of blood pressure, corresponding to the sex, age and centile of the patient's body length.

Comprehensive examination all children and adolescents with hypertension and high normal blood pressure (especially in the presence of aggravated heredity for hypertension) should go through.

Indications for measuring pressure in a newborn baby

To every sick newborn at least once on all 4 limbs.

Constantly (ideally intra-arterially):

Immature or sick newborn immediately after birth.
Shock (eg, asphyxia).
Ventilation with high pressure or high O 2 demand.
Persistent fetal circulation (PFC syndrome).

Periodically:

Premature (> 32 weeks of gestation) newborn on the 1st day of life.
With impaired respiratory adaptation.
Hourly (or more often) measurements until stabilization.
In the future, control blood pressure every 3 hours, and then every 8 hours in a child in the intensive care unit.

Methods for measuring blood pressure in a newborn baby

Direct measurement with sensors through an umbilical artery catheter or a. radialis:

Advantages:

Reliable data.
Permanent measurement.

Flaws:

The risk associated with the presence of a catheter in an artery.
Initially high material costs and burden on staff.

Duration: readings are reviewed daily! The maximum stay of an umbilical arterial catheter is one week, and a written justification is required for its extension.

Indirect blood pressure measurement oscillography method (Dinamap/ Philips monitors):

Advantages: easy-to-handle process of measurement and automatic saving of data.

Flaws: It is not possible to recognize measurement errors because only one value is received. Erroneously high systolic pressure (up to + 20 mm Hg. Art.) Is fraught with unrecognized hypotension.

As a rule, larger cuffs (covering the entire shoulder) are used more often; The cuff should cover 2/3 of the shoulder.

Equipment:

Monitor/module with channel for direct pressure measurement and connecting cable.
Disposable transducer with measurement chamber and disposable blood pressure measurement kit.
Perfusor with syringe.
Infusion solution: 0.45% NaCl + 1 unit heparin/ml.

Training:

Observe the conditions of sterility during work and do not allow air bubbles to enter: When connecting connectors, always “moisten with a drop of water” and tighten quickly. Assemble the system outside the incubator.
Assemble the complete system.
Using a syringe, first fill the measuring chamber through a special valve. Advice: aspirate a large gas bubble and clean the entire wall with it (a large bubble will absorb small ones!).
By changing the position of the measuring chamber, fill it from bottom to top.
Now fill the rest of the system, connect to the catheter and calibrate (see below).

Calibration

Perform zero calibration (every 8 hours).
Position the measurement chamber at mid-chest height.
Shut off the tap between the measuring chamber and the child, open the tap of the measuring chamber to the atmosphere.
Press and hold the zero (0) button on the monitor until a beep sounds (approximately 1-2 seconds).
Now first turn off the faucet to the air, and then open the faucet to the child.
Connect a perfusor (typically continuous infusion at a rate of 0.3-0.5(-1) ml/h).

Evaluation of pressure curve data:

The waveform should be biphasic/dicrotal (closing of the aortic valve).
If the curve is flattened (damped), only the average pressure is displayed on the monitor.
Causes of damping: Air in the system, obstruction of the catheter, or the catheter is attached to the vascular wall. The catheter is in a. femoralis. If no air bubbles are found, try aspirating blood clots.

Carefully: do not flush the clots into the vessel, if unsuccessful, remove the catheter.