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Since many health problems, including cardiovascular
diseases, originate in childhood, the current epidemic of
childhood obesity in the United States has led many medical
experts to re-examine and update their recommendations for
measures to help protect children's health.

In order to detect potential medical problems as early as
possible, the American Academy of
Pediatrics has endorsed the recommendations of a national
children's health group calling for blood pressure screenings
to begin for most children at age three.

Jennifer Cheng, M.D., pediatrician at Duke University
Medical Center, said the new guidelines reflect the health
community's concern about a growing health crisis among U.S.
children, especially the incidence of childhood obesity.

"Part of the impetus for this change is probably the
increased incidence of pediatric obesity," Cheng said. "We are
dealing with a major epidemic. One out of three children is
either overweight or obese. We are seeing rising rates of
obesity, hypertension and diabetes.

"Blood pressure monitoring should be done annually for most
children and even earlier for children with underlying medical
conditions, such as heart disease, renal problems, endocrine or
metabolic disorders. If the reading is abnormal, it should be
repeated on at least three different occasions, to document
that truly is a problem."

Cheng says screening methods for small children are similar
to those for adults, with certain adjustments.

"It is done in the same manner, however standards differ for
children," she explained. "Blood pressure values for children
depend on their age, gender and height. Because blood pressure
actually increases with age, this also helps to avoid
misclassifying children at the extreme ends of the growth
spectrum, when they may actually not actually have
hypertension."

While high blood pressure can 'run in families,' Cheng said
the causes of the condition in children are actually quite
complex.

"We don't know the exact cause of what we call essential
hypertension just yet. It probably is a result of the interplay
of multiple factors, including genetic predisposition and
environmental factors.

"Basically a normal reading is a systolic and diastolic
blood pressure that fall within the 90th percentile for age,
gender and height. A hypertensive child has a blood pressure
that is at the 95th percentile or greater. A child who is
considered 'pre-hypertensive' has a blood pressure that is
between the 90th and 95th percentile for age, gender and
height."

Cheng said early diagnosis, lifestyle changes and medication
if needed can help prevent many long-term diseases. She added
that families can play a key role in helping manage a child's
blood pressure.

"We want to focus on things families can do at home,
especially eating a sensible diet and exercising. Lifestyle
modification can definitely be a very effective tool in
preventing and treating hypertension, if it's not severe or
associated with other medical problems. If that fails,
medications are available. However they are not without side
effects and should not be used except in special
situations.

"A lot of these risk factors begin in childhood and if
undetected they end up causing severe, significant organ damage
in multiple systems: the heart, the eyes, the kidneys. It can
be a major health problem for a lot of these young
children."