The 2017 American Academy of Pediatrics (AAP) Clinical Practice Guidelines recommends routine blood pressure (BP) measurement in children under 3 years of age who have conditions that place them at increased risk for hypertension. However, blood pressures are rarely done during well-child visits in this young, high-risk population. 

In response to this gap in routine screening, Children’s Hospital of Philadelphia (CHOP), in partnership with the Magical Mila Foundation, is advancing a standard-of-care approach to obtaining accurate BP measurements in children younger than 3 years who are at high risk of developing hypertension.

Conditions under which children < 3 years should have BP measured

Multiple clinical conditions are associated with an elevated risk of hypertension in this age group. Children are at higher risk if they have one of the following conditions. If your patient under the age of 3 has a condition placing them at increased risk for developing hypertension, it is crucial for them to have their blood pressure checked at every well-child visit.

High-risk conditions, per AAP guidelines*

• History of prematurity:  < 32 weeks gestation or small for gestational age; very low birth weight; other neonatal complications that require intensive care; having an umbilical artery line 
• Congenital heart disease (repaired or unrepaired) 
• Recurrent urinary tract infections, hematuria or proteinuria 
• Known renal disease or urologic malformations 
• Family history of congenital renal disease 
• Solid-organ transplant 
• Malignancy or bone marrow transplant 
• Treatment with drugs that are known to raise BP 
• Other systemic illnesses associated with HTN (neurofibromatosis, tuberous sclerosis, sickle cell disease, etc.) 
• Evidence of elevated intracranial pressure
• Genetic conditions including fibromuscular dysplasia and Alagille, Turner and Williams syndromes

* Source: 

https://publications.aap.org/pediatrics/article/140/3/e20171904/38358/Clinical-Practice-Guideline-for-Screening-and