Many children have no symptoms of high blood pressure, although some children with high blood pressure may have signs and symptoms such as:

• Chest pain
• Fatigue
• Difficulty concentrating
• Headaches
• Difficulty sleeping

In severe cases, your child might have signs and symptoms such as blurred vision, shortness of breath or confusion.

When to see a doctor
Unless your child has an underlying health problem or has the emergency symptoms listed above, you probably don't need to make a special visit to your child's doctor to have your child's blood pressure checked. However, your child's blood pressure should be checked yearly as part of a routine doctor's appointment, starting when your child is age 3.

If your child has a condition that can increase the risk of high blood pressure — including premature birth, low birth weight, congenital heart disease, and certain urinary or kidney problems — blood pressure checks may begin during infancy.

If you're concerned about your child having risk factors for high blood pressure, such as being overweight or obese, talk to your child's doctor. He or she may recommend more frequent blood pressure checks.

Blood pressure should also be checked at least once during a course of treatment for any acute illness. If your child has pneumonia, for example, and has two or three visits to the doctor, his or her blood pressure should be checked at least once.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

High blood pressure in younger children is often related to other health conditions such as heart defects, kidney disease, genetic conditions or hormonal disorders. In older children — especially those who are overweight — the precise cause of high blood pressure is often unknown.

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Your child's risk factors for high blood pressure depend on whether it's caused by another health condition your child has, or lifestyle factors.

Secondary hypertension
Secondary hypertension is high blood pressure that's caused by an underlying health condition. This is the type of high blood pressure that's more common in young children. Other health conditions that can cause high blood pressure include:

• Chronic kidney disease
• Polycystic kidney disease
• Type 1 diabetes
• Heart problems, such as coarctation of the aorta
• Adrenal disorders
• Conditions affecting the kidneys, such as lupus
• Hyperthyroidism
• Pheochromocytoma, a rare tumor in the adrenal gland
• Narrowing of the artery to the kidney (renal artery stenosis)

Essential hypertension (primary hypertension)
Essential hypertension is high blood pressure that occurs on its own, without an underlying condition. This type of high blood pressure occurs more often in older children and adolescents. The risk factors for developing essential hypertension are:

• Being overweight or obese (a body mass index over 25)
• Lack of physical activity
• Type 2 diabetes or a high fasting blood glucose level
• High cholesterol and triglycerides
• Too much salt (sodium) in your child's diet

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Children who have high blood pressure are likely to continue to have high blood pressure as adults unless they begin treatment.

A common complication of high blood pressure in children is sleep apnea, a condition in which your child may snore or have abnormal breathing when he or she sleeps. Pay attention to breathing problems your child may have while sleeping. Children who have sleep-disordered breathing, such as sleep apnea, often have problems with high blood pressure - particularly children who are overweight.

If your child's high blood pressure persists into adulthood, your child could be at risk of:

• Stroke
• Heart attack
• Heart failure
• Kidney disease

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

There are no special preparations necessary for your child's blood pressure to be checked. Your child's blood pressure will likely be checked as part of a routine doctor's appointment.

If you have concerns about how often your child's blood pressure is being checked, talk to your child's doctor.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

The test for high blood pressure is painless. Blood pressure is measured with an inflatable arm cuff and a pressure-measuring gauge. Your child may feel a tight squeeze around the arm when the cuff is inflated. You can find out what your child's blood pressure is immediately after the test is over.

A blood pressure reading has two numbers. The first, or upper, number measures the pressure in your child's arteries when his or her heart beats (systolic pressure). The second, or lower, number measures the pressure in your child's arteries between beats (diastolic pressure).

Normal blood pressure readings in children vary based on sex, age and height, so what may be a high blood pressure reading for a 4-year-old boy may be normal for a 10-year-old girl. The readings are classified by percentile, similar to the way height and weight are charted for children's growth. For example, if your child's blood pressure is in the 75th percentile, that means 75 percent of children have the same or lower blood pressure than does your child.

Your child's doctor should tell you your child's blood pressure percentile and category. If you know your child's blood pressure measurement, you can also look up his or her percentile using tables from the National Heart, Lung, and Blood Institute.

*Percentiles are based on your child's sex, age and height.

Your child won't be diagnosed with high blood pressure after only one blood pressure measurement. To diagnose high blood pressure, it takes three measurements that show your child's blood pressure is higher than normal over the course of at least three visits to the doctor.

If your child's blood pressure is higher than normal, it should be checked every four to six months after high blood pressure is first diagnosed.

If your child is diagnosed with prehypertension or hypertension, your child's doctor may also perform these tests to see if another condition is causing your child's high blood pressure:

• Blood test to check your child's blood sugar, kidney function and blood cell counts
• Urine sample test (urinalysis)
• Echocardiogram, a test to check the blood flow through your child's heart, if your child's doctor suspects a heart problem may be causing high blood pressure
• Ultrasound of your child's kidneys

If your child's doctor is having difficulty diagnosing high blood pressure, or wants to monitor your child's treatment, he or she may recommend ambulatory monitoring. In ambulatory monitoring, your child wears a device that measures his or her blood pressure throughout the day. This is not yet common practice, and more research is necessary to see if ambulatory monitoring helps in the treatment and diagnosis of high blood pressure in children.

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Lifestyle changes, including a heart-healthy diet and exercise, are often the first approach your child's doctor will recommend to lower his or her blood pressure.

If your child is diagnosed with slightly or moderately high blood pressure (prehypertension or stage 1 hypertension), your child's doctor will likely suggest trying lifestyle changes, such as a heart-healthy diet and more exercise, before prescribing medications. If your child's blood pressure doesn't decrease after trying lifestyle changes for four to six months, your child's doctor may recommend blood pressure medication. If your child is diagnosed with severely high blood pressure (stage 2 hypertension), your child's doctor will likely recommend blood pressure medications. These medications may include:

• Diuretics. These medications, also known as water pills, act on your child's kidneys to help your child eliminate sodium and water, reducing blood pressure.
• Beta blockers. These medications reduce the workload on your child's heart, causing it to beat slower and with less force.
• Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax your child's blood vessels by blocking the formation of a natural chemical that narrows blood vessels. This makes it easier for your child's blood to flow, reducing blood pressure.
• Angiotensin II receptor blockers. These medications help relax blood vessels by blocking a natural chemical that narrows your child's blood vessels.
• Calcium channel blockers. These medications help relax the muscles of your child's blood vessels and may slow his or her heart rate. Calcium channel blockers can have a dangerous interaction with grapefruit juice, however, so talk to your child's doctor if you regularly serve grapefruit juice to your child.

Your child may need blood pressure medications temporarily or indefinitely. If your child's high blood pressure is caused by obesity, losing weight may eliminate the need for medication. In other cases, treating other medical conditions your child has might control his or her blood pressure.

Although little is known about the long-term effects of blood pressure medication on a child's growth and development, research shows these medications are safe to take during childhood. Depending on the specific drug, side effects are possible, including dry mouth, dizziness, flushing and fatigue.

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High blood pressure is treated similarly in children and adults, typically starting with lifestyle changes.

• Control your child's weight. If your child is overweight, losing the excess pounds or maintaining the same weight as he or she gets taller can lower blood pressure.
• Give your child a healthy diet. Encourage your child to eat a healthy breakfast that includes fiber, and avoid sugary cereals. Provide plenty of fresh fruits and vegetables in place of higher fat snacks like candy or chips. Trade white bread, rice and pasta for whole-wheat varieties. Working with a dietitian can be helpful.

• Decrease salt in your child's diet. One of the most important changes you can make to decrease your child's blood pressure is to cut the amount of salt (sodium) in your child's diet. Children age 3 and younger shouldn't have more than 1,500 milligrams (mg) of sodium a day. Children ages 4 to 8 shouldn't have more than 1,900 mg a day, and children ages 9 to 13 shouldn't have more than 2,200 mg a day. Starting at age 14, the daily sodium allowance is the same as it is for adults — 2,300 mg or less a day.

  Pay attention to how much salt you use in your cooking, and take the saltshaker off the table. Avoid giving your child salty snacks, such as chips or pretzels. Also, pay attention to how much sodium is in canned and processed foods your child eats, such as soups and frozen dinners.

• Encourage physical activity. Most children need at least 30 to 60 minutes of physical activity a day. To promote physical activity, limit your child's time in front of the television or computer — no television before age 2, and no more than two hours of "screen time" a day after age 2.
• Get the whole family involved. It may be hard for your child to make healthy lifestyle changes if you or your child's siblings don't eat a healthy diet or exercise. So, set a good example. Your whole family will benefit from eating a healthier diet. You can also join in the fun of riding your bikes together, playing catch or walking to the park as a family.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

High blood pressure caused by another condition can sometimes be controlled, or even prevented, by effectively managing the underlying condition. Essential high blood pressure can be prevented in children by making the same lifestyle changes that can help treat it — controlling your child's weight, providing a healthy diet and encouraging your child to exercise.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.