Testing & diagnosis for hypertension in children

In diagnosing hypertension at Boston Children's Hospital, we look at two things: whether a child actually has hypertension, and if so, what could be causing it.

Does the child have hypertension?

Two steps are required to determine whether a child truly has hypertension:

1. There are very clear guidelines about how to measure a child’s blood pressure, but sometimes they aren’t followed, and the results can be misleading. These guidelines include making sure that:

  • the cuff that clinicians use to measure blood pressure is the right size for the child
  • the cuff is placed in the proper position
  • the child is seated in the proper position
  • the child is relaxed (hasn’t just run up four flights of stairs to the doctor’s office)

The doctor will then compare the numbers from the blood pressure reading to a chart blood pressure values, to see which percentile your child’s blood pressure falls into.

2. In order to be diagnosed with hypertension, there needs to be a pattern of elevated blood pressure. This pattern can be established in a few different ways:

  • Blood pressure could be measured on three different doctor’s office visits. Depending on how high the child’s first blood pressure reading was, these visits may be separated by a week or less. The higher the blood pressure, the more closely together the visits will be.
  • A parent may feel comfortable taking his or her child’s blood pressure at home.
  • The child’s school nurse might take the blood pressure.
  • Your child might be asked to wear an ambulatory blood pressure monitor.

What could be causing the hypertension?

The next step is to look for any damage to your child’s organs that might have already occurred, and find out what is causing the high blood pressure.

First, her doctors will run screening tests, including:

  • urine tests
  • blood tests

Based on the results of those tests, other tests may be ordered, including:

  • kidney ultrasound
  • echocardiogram
  • other diagnostic imaging
  • eye exam

How are infants diagnosed with hypertension?

It can be challenging to diagnose hypertension in infants because most pediatricians don’t start checking blood pressure until a child is two years old. But if an infant has risk factors for hypertension, her doctors will monitor her blood pressure. These factors include:

  • being born prematurely
  • having a history of urinary tract infection or other kidney problem
  • having a history of heart disease
  • being small for gestational age/weight at birth

Hypertension in an infant has a much higher probability of being caused by an underlying condition, so doctors are very thorough when looking for signs of one. In addition to the diseases and conditions they’d look for in an older child, they’ll also look for blood vessel malformations of the aorta and kidney.

After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child's condition. Then we will meet with you and your family to discuss the results and outline the best treatment options.