Hypotension or low blood pressure in children can be due to various reasons. This is when the systolic or top reading pressure goes below 90mmHg, and the diastolic pressure or the bottom reading is below 60mmHg (1). According to most pediatric care guidelines, these blood pressure measures are less than the 5th percentile for children aged ten years or more. However, the normal measurements may vary in younger children. So you may seek pediatricians’ help to determine hypotension in children......See Full Story>>.....See Full Story>>
Read on to know more about the causes, symptoms, and management of low blood pressure in children.
Types Of Low Blood Pressure (Hypotension) In Children
The threshold of blood pressure in adults is usually static. However, it differs in children based on their age, height, and gender percentile (2). Hypotension can be classified into four categories:
Orthostatic hypotension: It happens when a child’s blood pressure falls when they are in a standing posture for a long time. They may have symptoms such as headache, weakness, and difficulty in vision (3).
Neurally mediated hypotension: Also known as syncope, or more commonly vasovagal syncope, it is caused when the brain and heart have an abnormal reflex interaction due to a glitch in the autonomous nervous system. It could occur when the child is in a warm surrounding, has been standing for long, after exercise, or after eating (4) (5). Also, neurological disorders like spinal cord injury, or multiple sclerosis can lead to hypotension (6).
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Neurally mediated hypotension can also be triggered when the child witnesses gory or unpleasant events, sees blood, or when they are anxious (4).
Severe hypotension: It is a substantial drop in blood pressure due to severe infection, loss of excess blood, severe allergy, injury, or trauma (7).
Low blood pressure in children could be caused due to various factors or could be the result of a condition or an event.
Causes Of Low Blood Pressure In Children
Some of the common causes that affect children are mentioned below.
Dehydration: When there is an excess loss of water from the body, it causes dehydration. Low blood pressure can be one of the several symptoms of mild to severe dehydration in children (8).
Allergies: An allergy occurs when the immune system mounts an attack on a usually harmless allergen. A severe allergic reaction is called anaphylaxis. This condition could lead to low blood pressure (9).
Infections: Hypotension may happen in cases of severe infection. Sepsis or septic shock caused by a severe infection can also result in hypotension (10).
Iron deficiency anemia: A 2019 study by the Pan American Health Organization (PAHO) indicated that 6.1% of children (aged 6 to 59 months) in the US have iron deficient anemia. Low blood pressure could be one of the several symptoms of iron deficiency anemia (11). Hypotension is likely to be among the symptoms that occur when the anemia in children becomes severe.
Heart problem: According to the statistical report from 2021 by the American Heart Association, congenital heart defects are prevalent across 6.9 per 1000 live births in North America. A fall in blood pressure could be a symptom of heart failure, congenital heart defects, or other heart-related issues among children. Some other symptoms include trouble breathing, excessive sweating, and poor development (12). Orthostatic hypotension can also be caused due to arrhythmias or irregular heartbeat (13).
Injury or trauma: An injury can lead to external or internal blood loss, which may cause a drop in blood pressure. Low blood pressure is often among the many symptoms of a severe abdominal injury, which causes internal bleeding (14).
Nutritional deficiencies and metabolic problems: A deficiency in nutrients, like folic acid and vitamin B12, which may have been caused by malnutrition, could also lead to hypotension. Problems in the endocrine system (glands that secrete hormones) may also be a reason (15) (1).
Physical stress: Standing or sitting for too long, prolonged exposure to the sun during summer, intense exercise, and emotionally stressful events might also trigger low blood pressure.
Addison’s Disease: Addison’s disease is caused due to damage of the adrenal glands which results in reduced secretion of the hormone cortisol. With adrenal insufficiency, the body is not able to increase the amount of cortisol which leads to an Addisonian crisis that results in low blood pressure (16).
Hypovolemia: This is a condition that causes a reduction in blood circulation and in extreme cases, arterial hypotension (17).
Pulmonary Embolism: This is a condition in which a blood clot originates in a large vein, mostly in the legs, and moves to the lungs, causing difficulty in breathing and low blood pressure (18).
Hypoglycemia: This condition occurs when the body experiences abnormally low levels of blood sugar or glucose, often resulting from diabetes. This can trigger an elevated heart rate in children and a decrease in central blood pressure (19).
Hyperthyroidism: The regulation of blood pressure may be impacted by an overabundance of thyroid hormone, leading to the relaxation of blood vessels and a decrease in diastolic blood pressure (20).
Cancer: It is seen that cancer treatments like chemotherapy or certain biological drugs can cause low blood pressure (21).
Some research has suggested that low blood pressure might also be caused by certain genetic disorders too. However, sometimes it is difficult to figure out that the blood pressure of the child is low. But knowing the symptoms may help.
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Certain prescription medications, alcohol, recreational drugs, and extreme temperatures can also trigger hypotension in kids (23).
Signs And Symptoms Of Low Blood Pressure In Children
Fainting or dizziness in children is a common symptom of low blood pressure. Some other symptoms a child with low blood pressure may experience include (1).
Dizziness or fainting
Tiredness
Nausea
Difficulty to focus
Blurred vision
Feeling sick
Breathing difficulties
Some children show mild symptoms, like headaches and chronic fatigue, which may or may not indicate a fall in blood pressure. However, if these symptoms persist, take your child to a doctor, as untreated hypotension can lead to long-term health issues.
Diagnosis Of Low Blood Pressure In Children
A doctor will use the following steps to diagnose low blood pressure (24).
Assessment of symptoms: The doctor will check symptoms related to low blood pressure and may ask parents about any existing medical problems in the child.
Auscultatory blood pressure measurement: The doctor uses a manual or digital sphygmomanometer, which is a blood pressure measurement machine, to check the blood pressure of the child.
Pulse determination: Fingers are placed on an artery to feel the pulse. It helps in knowing the number of heartbeats per second.
ECG: If some anomalies are detected, then the doctor might suggest further checkup of the heart with an ECG machine.
Treatment For Low Blood Pressure In Children
If the blood pressure has dropped due to any medical condition such as heart disease or infections or allergies, then the doctor may prescribe medications for it (25) (26).
If medication side effects like a drop in blood pressure is observed, then the medications may be changed as per the symptoms and health condition of the child.
Low blood pressure in children is often manageable at home when it is due to physical stress, dehydration, or poor diet.
Home Care Tips For Children With Low Blood Pressure
A home care routine can help make low blood pressure manageable and may even help restore normal blood pressure.
Food that contains sodium could help in maintaining the blood pressure. Savory snacks, cured meats, cheese, chicken, soups, and bread have sodium content (27). You may speak to a pediatrician or a pediatric dietician to know about the right quantity of sodium your child needs at their age.
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Consuming almonds, and raisins and drinking carrot and beetroot juice can help manage low blood pressure (28).
A well-balanced diet is essential to maintaining blood pressure. Include vegetables, fruits, and nuts in your daily diet. Fruits and vegetables high in water content can help maintain hydration. Foods rich in folic acid and vitamin B12 should also be included in regular meals.
Drinking adequate water can help prevent dehydration, which is one of the causes for low blood pressure in children.
Tell your child to slow down the pace of any strenuous physical activity. The child must avoid standing or sitting for too long, especially in warm outdoors.
Compression stockings can help maintain optimum blood pressure in the upper body and prevent blood from pooling in the legs. Speak to the child’s doctor about the use of stockings for your child.
Infographic: Measuring Blood Pressure At Home
While trying to manage your child’s blood pressure (BP), the first thing to do is study their numbers. Fortunately, this doesn’t require you to visit a clinic frequently. A one-time investment in a reliable BP apparatus and some training regarding its operation will do.
Let us help you study your child’s BP number. Here is a handy infographic discussing the steps of measuring blood pressure at home.