When and How to Measure Blood Pressure in Children

Why the Cuff and Stethoscope Is Still the Best Method

Pediatric's office nurse with patients
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There's been a recent disturbing upward trend in the number of children being diagnosed with high blood pressure and this has led many experts to believe that kids' blood pressure isn't being measured often enough.

When Children Should Get Blood Pressure Checked

Currently, the National Institutes of Health National Heart, Lung and Blood Institute (NHLBI) recommends routine blood pressure measurements starting at 3 years old.

In general, children younger than 3 years old only need regular blood pressure checks if they:

  • Are seriously overweight or underweight
  • Stayed in the ICU (intensive care unit) for any amount of time after birth
  • Have/had any known heart, lung or circulatory problems
  • Experienced any complications or difficulty before, during, or shortly after birth

The blood pressure readings taken at the doctor’s office will become a part of your child’s medical record and will allow your doctor to track blood pressure trends over time in order to more easily detect any potential problems.

Proper Technique for Taking Blood Pressure Is Essential

The proper technique for taking a blood pressure reading in children is the same as for measuring blood pressure in adults and essential for accuracy. 

One large study that looked at how well doctors and nurses perform the task of measuring blood pressure found that even small errors in measuring technique can skew readings by as much as 10- to 15-percent -- enough to create concern when things are actually fine, or prevent further investigation when it should be made.

Blood Pressure Reading Best Practices

During this procedure, parents and other caregivers should watch the health practitioner ensure the following best practices are followed.

  • Cuff size: Since an incorrectly sized cuff can produce falsely high or falsely low readings, ensure the provider takes the time to choose the correct one. The proper cuff size for your child depends on the size of their arm and is usually the largest cuff that fits while still leaving room for the head of the stethoscope.
  • Timing: Recent physical activity can skew an otherwise good reading. Therefore, wait until your child has been relatively calm for at least 5 minutes before you begin. During the procedure, children should sit down and try to relax -- take a couple of deep breaths together may help calm an anxious kid.
  • Repetition: Your child's health care practitioner should take at least two separate readings during each visit. While these readings must be taken at least two minutes apart, there is some data to suggest that taking the readings at the beginning and end of the appointment may provide more accurate results.
  • Consistency: One practitioner should take the two blood pressure readings, whenever possible. For the most consistent results, the NHLBI recommends using the Gold Standard for measuring blood pressure, which is the "old fashioned" way with a cuff and stethoscope. If an automated device detects a high reading the first time, it recommends switching to the Gold Standard for the second one, instead of taking another digital reading.
    View Article Sources
    • Pickering, TG, Hall, JE, Appel, LJ, et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the subcommittee of professional and public education of the American Heart Association Council on High Blood Pressure Research. Circulation 2005; 111:697.
    • Williams, CL, Hayman, LL, Daniels, SR, Robinson, TN. Cardiovascular health in childhood: A statement for health professionals from the Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2002; 106:143.
    • Recommendations for routine blood pressure measurement by indirect cuff sphygmomanometry. American Society of Hypertension. American Journal of Hypertension 1992; 5:207.
    • Beevers, G, Lip, GY, O'Brien, E. ABC of hypertension. Blood pressure measurement. Part II – Conventional sphygmomanometry: Technique of auscultatory blood pressure measurement. BMJ 2001; 322:1043. Gillman, MW, Cook, NR. Blood pressure measurement in childhood epidemiological studies. Circulation 1995; 92:1049.
    • National Institutes of Health National Heart, Lung and Blood Institute: A Pocket Guide to Blood Pressure Measurement In Children (2007).