26
Nov

High Blood Pressure in Children

High Blood Pressure in Children

Can children get high blood pressure?

We usually think of high blood pressure, or hypertension, as a problem that affects adults. But, in fact, this condition can be present at any age, even in infancy. About 5 of every 100 children have higher than normal blood pressure, although fewer than 1 in 100 has medically significant hypertension.

How blood pressure is measured?

The term blood pressure actually refers to two separate measurements:

  • Systolic blood pressure is the highest pressure reached in the arteries as the heart pumps blood out for circulation through the body.
  • Diastolic blood pressure is the much lower pressure that occurs in the arteries when the heart relaxes to take blood in between beats.

If either or both of these measurements are above the range found in healthy people of the same age and sex, it’s called hypertension.

Causes

In many cases, hypertension seems to develop with age. As a result, your child may show no signs of high blood pressure as an infant, but may develop the condition as she grows.

Children who are overweight are much more prone to have hypertension (as well as other health problems). By age 7, more than 50% of hypertension is due to obesity and this rises to 85-95% by adolescent years. Thus, good eating habits (without overeating and without emphasizing high-fat foods) and plenty of physical activity are important throughout the early years of childhood (and for the rest of her life).

When hypertension becomes severe in children, it’s often a symptom of another serious problem, such as kidney disease or abnormalities of the heart or of the nervous or endocrine (gland) system.

Early detection is key

Fortunately, high blood pressure can be controlled through dietary changes, medication, or a combination of the two.

However, if hypertension is allowed to continue or become worse over many years, the prolonged extra pressure can lead to heart failure or stroke in adulthood. Also, long-term hypertension causes changes in blood vessel walls that may result in damage to the kidneys, eyes, and other organs. For these reasons it’s important for children with hypertension to have their blood pressure checked regularly by their pediatrician, and for you to follow the doctor’s treatment advice carefully.

Signs and symptoms

In most routine physical examinations, your child’s blood pressure will be measured. This is how hypertension is usually discovered. Most often this condition causes no noticeable discomfort, but any of the following may indicate high blood pressure:

  • Headache
  • Dizziness
  • Shortness of breath
  • Visual disturbances
  • Fatigue

Diagnosis

If your child is found to have high blood pressure, your pediatrician will order tests to see if there is an underlying medical problem causing it. These tests include studies of the urine and blood. Sometimes special X-rays are used to examine the blood supply to the kidneys. If no medical problem can be found, your child will be diagnosed with essential hypertension. (In medical terms, the word essential refers only to the fact that no cause could be found.)

Managing your child’s high blood pressure

What will the doctor tell you to do? If obesity is the cause, the first step will be to have your child lose weight. This will need to be very closely monitored by your pediatrician. Not only will weight loss lower blood pressure, it can provide many other health benefits as well.

The next step toward reducing our child’s blood pressure is to limit the salt in her diet. Giving up the use of table salt and restricting salty foods can reverse mild hypertension and will help lower more serious blood pressure levels. You’ll also have to be cautious when shopping for packaged foods; most canned and processed foods contain a great deal of salt, so check labels carefully to make sure the items have little or no salt added.

Your pediatrician also may suggest that your child get more exercise. Physical activity seems to help regulate blood pressure and thus can reduce mild hypertension.

Medication

Once your pediatrician knows your child has high blood pressure, he’ll want to check it frequently to make sure the hypertension is not becoming more severe. Depending on how high the blood pressure is, the pediatrician may refer the child to a child hypertension specialist, usually a pediatric nephrologist (kidney specialist) or pediatric cardiologist (heart specialist). If it does become worse, it may be treated with medication as well as diet and exercise.

Many types of medications are available, which work through different parts of the body. When your child’s blood pressure is brought under control with diet or medication it is important to continue the treatment according to your doctor’s recommendations, including changes in diet, or the hypertension will return.

Prevention

It’s very important to detect hypertension early. Uncontrolled long-standing hypertension can have damaging ef­fects on several other organs in the body such as the heart, kidneys, and brain.

It is now recommended that all children have their blood pressure checked beginning at age three, sooner for those at high risk. These include infants who were preterm, or of low birth weight, who had a difficult or prolonged hospital stay. It also includes children who have congenital heart disease, who are receiving medications that might increase blood pressure, or who have any other condition that might lead to high blood pressure.

Because overweight children are more likely to develop hypertension (as well as other health problems), watch your child’s caloric intake and make sure she gets plenty of exercise. Even relatively small decreases in weight or small increases in physical activity may prevent hypertension in overweight children.

Last Updated 11/21/2015

26
Nov

Heart Murmur

Heart Murmur

What is a heart murmur?

Technically, a heart murmur is simply a noise heard between the beats of the heart. When a doctor listens to the heart, she hears a sound something like lub-dub, lub-dub, lub-dub. Most often, the period between the lub and the dub and between the dub and the lub is silent. If there is any sound during this period, it is called a murmur. Although the word is unsettling, murmurs are extremely common, and usually normal (that is, the sounds are causes by a healthy heart pumping blood normally).

“Innocent” murmurs

In preschool and school-age children, heart murmurs are almost always not a concern; the children require no special care, and the sound eventually disappears. These children have “normal” or so-called functional or innocent heart murmurs.

If your child has such a murmur, it probably will be discovered between the ages of one and five during a routine examination. The doctor then will listen carefully to determine if this is a “normal” heart murmur or one that might indicate a problem. Usually, just by listening to its sound, the pediatrician will be able to tell if a murmur is innocent (normal). If necessary, she will consult a pediatric cardiologist to be certain, but additional tests are usually not necessary.

On rare occasions, a pediatrician will hear a murmur that sounds abnormal enough to indicate that something might be wrong with the heart. If the doctor suspects this, your child will be referred to a pediatric cardiologist to enable a precise diagnosis to be made.

Heart murmurs and infants

When do heart murmurs become a concern? When they occur very early at birth or during the first six months of life. These murmurs are not functional or innocent, and most likely they will require the attention of a pediatric cardiologist immediately. They may be due to abnormal connections between the pumping chambers (septal defects) or the major blood vessels coming from the heart (e.g., transposition of vessels). Your infant will be observed for changes in skin color (turning blue), as well as breathing or feeding difficulties. He also may undergo additional tests, such as a chest X-ray, electrocardiogram (ECG), and an echocardiogram. This echocardiogram creates a picture of the inside of the heart by using sound waves. If all of these tests prove normal, then it is safe to conclude that the baby has an innocent murmur, but the cardiologist and pediatrician may want to see him again to be absolutely certain. The cardiologist and pediatrician together will make a decision as to next steps depending on the results of these tests.

When a specific condition called patent ductus arteriosus (PDA) occurs, it is often detected shortly after birth, most commonly in premature babies. It is a potentially serious condition in which blood circulates abnormally between two of the major arteries near the heart, due to the failure of a blood vessel (the ductus arteriosis) between these arteries to properly close. In most cases, the only symptom of PDA is a heart murmur until the ductus closes on its own shortly after birth, which often happens in otherwise healthy, full-term newborns. Sometimes, especially in premature babies, it may not close on its own, or it may be large and permit too much blood to pass through the lungs, which can place extra strain on the heart, forcing it to work harder and causing a rise in blood pressure in the arteries of the lungs. If this is the case, a medication or, rarely, surgery may be needed to help close the PDA.

Treatment

Innocent heart murmurs  are normal and therefore require no treatment. Children with these innocent heart murmers do not need repeated evaluation or long-term follow-up care from cardiologist, nor do they require restrictions on sports or other physical activities.

Innocent heart murmurs generally disappear by midadolescence. Cardiologists don’t know why they go away, any more than we know why they appear in the first place. In the meantime, don’t be discouraged if the murmur is softer on one visit to the pediatrician and loud again on the next. This may simply mean that your child’s heart is beating at a slightly different rate each time. Most likely the murmur will go away eventually.

Patent ductus arteriosus is a selfcorrecting problem in some cases, or medications can be used to close a PDA. But if the ductus arteriosus remains open, it may need to be corrected surgically or with a catheter.

If other, more serious, heart conditions are diagnosed from birth or shortly thereafter, and the evaluation reveals more serious defects, the pediatric cardiologist and pediatrician will consult a pediatric cardiac surgeon at a regional Pediatric Cardiac Center where complete pediatric cardiac diagnostic and intervention capabilities exist.

Last Updated 11/21/2015
26
Nov

Genetics and Congenital Heart Defects

Genetics and Congenital Heart Defects

A congenital heart defect (CHD) is the most common type of birth defect. It is estimated that 2 to 3 million people in the United States have a CHD.

Over the last few decades, treatments for CHDs have improved—meaning more children born with a CHD are growing up to have children of their own.

If you have a CHD, you might wonder what the risk is for your child to also have a CHD. You might also wonder whether pregnancy will affect your health. These are very important questions to discuss with your congenital cardiologist and perhaps other specialists, such as a maternal-fetal-medicine specialist and a geneticist or genetic counselor.

What causes a congenital heart defect?

CHDs are caused by genetics, the environment, or a combination of both. Some known genetic causes include:

  • Chromosome abnormalities: Extra or missing chromosomes.
  • Gene mutation: A change to the DNA sequence or order that makes up a gene.

About genetic testing:

There are two types of tests used with genetic testing: chromosomal and DNA. Recent advances in these tests have made it more possible to find the genetic cause of CHDs for many patients. Sometimes, however, a genetic change cannot be identified, but the cause can still be genetic.

How to reduce your baby’s risk of a congenital heart defect:

If you have a CHD, your baby has a higher risk of being born with a CHD. In fact, there is about a 5% chance your child will have a CHD, too. A geneticist or genetic counselor can help you determine if genetic testing might be helpful for you prior to becoming pregnant. See Preconception Counseling for Women with a Congenital Heart Defect for more information.

You might be asking yourself:

  • What can I do to lower my baby’s chance of being born with a CHD?
  • How might I be able to improve my baby’s outcome if he or she has a CHD? 

These are important questions to ask your medical care team, but some research suggests taking folate prior to conception and during pregnancy may decrease the risk of a CHD.

How a congenital heart defect is diagnosed in an unborn baby:

A CHD can be diagnosed very early in pregnancy (around 18 to 20 weeks) via an ultrasound of the baby’s heart, called a fetal echocardiogram.

If you have a CHD caused by a genetic change, your maternal-fetal-medicine specialist can perform either an amniocentesis or chorionic villus sampling to determine whether your unborn baby has the same genetic change. Both of these tests are done by inserting a needle into the womb to get a small tissue sample for testing

Additional information regarding congenital heart defects and lifelong cardiac care is available at the Congenital Heart Public Health Consortium (CHPHC) website, www.chphc.org. The CHPHC is housed at the American Academy of Pediatrics through a grant from the Centers for Disease Control and Prevention in an effort to utilize public health principles to affect change for those whose lives are impacted by a CHD. Organizational members of the Consortium represent the voice of providers, patients, families, clinicians and researchers.

Last Updated 11/7/2016