Checking blood pressure in young children isn’t something most families think about. But early, accurate screening can make a big difference for kids at risk of high blood pressure (hypertension).
CHOP's BP Under 3 Initiative helps to ensure these children get their blood pressure checked during regular visits, so any concerns can be identified and treated sooner.
With better tools, training and reminders, our medical team makes blood pressure checks a simple, routine part of care for the kids who need it most. It’s another proactive way CHOP helps to protect long-term heart, kidney and brain health, setting your child up for a healthier future.
What is the BP Under 3 initiative?
BP Under 3 is a clinical and quality improvement initiative that improves early detection of high blood pressure (BP) in children younger than 3 who are at increased risk of hypertension. The program promotes consistent, accurate, and routine BP measurement in primary and specialty care settings, establishing a new standard of pediatric care.
Developed by the Children’s Hospital of Philadelphia in collaboration with the Magical Mila Foundation, the initiative aims to scale this model locally, nationally and globally. Earlier diagnosis supports healthier futures for children through improved screening, coordinated care and tracked clinical outcomes.
Why is measuring blood pressure important for children under 3?
Blood pressure measurement in young children is critical because hypertension can be present early. If it goes unnoticed and untreated, it can cause serious organ damage. Early and accurate BP measurement allows the clinical team to identify true hypertension, initiate timely evaluation and treatment, and prevent long-term complications that affect the brain, heart and kidneys.
However, it can be difficult to obtain accurate BPs in children under three years. Challenges include the limitations of device technology, poor identification of the children who are most at risk, the clinical difficulties of measuring BP in infants, and a lack of appropriate education with the clinical team.
Who can benefit from this initiative?
BP Under 3 benefits children younger than 3 who are at increased risk for hypertension because of underlying medical conditions. Children face a higher risk if they have one of the following conditions:
- Congenital heart disease
- Renal disease
- Solid-organ transplant
- Bone-marrow transplant
- Various neonatal issues (low birth weight, less than 32 weeks' gestation, use of umbilical artery lines, ECMO)
- Many conditions and syndromes such as Alagille, Turner, Williams, and neurofibromatosis type 1
Collectively, this group represents 5% to 6% of the pediatric population seen in primary care.
How does the program work?
The 2017 American Academy of Pediatrics guidelines recommend BP measurement in children under 3 only when they are at increased risk for hypertension. Prior to this program’s implementation, providers did not have a reliable approach to identify these high-risk children at their well visits. BP Under 3 addresses this gap by systematically identifying high-risk children at their well visits and standardizing BP measurement in routine care.
BP Under 3 provides a comprehensive package of clinical tools and infrastructure, including:
- An Epic-based alert that flags high-risk children before and during well visits, prompting the clinical team to obtain a blood pressure measurement. This ensures consistent screening for children who meet high-risk criteria at their pediatrician visits who otherwise would have been missed.
- Widespread staff education on accurate BP measurement techniques in infants and toddlers.
- Distribution of ID badges summarizing key measurement principles and age-specific BP normative values.
- Webinars, educational sessions and hands-on training for clinical staff.
- Toolkits with posters and reference materials for exam rooms outlining best practices and protocols.
- A real-time electronic dashboard to track BP measurement rates, enable data analysis and identify opportunities for quality improvement.
Together, these components embed BP measurement into routine care for high-risk children under 3 and create a sustainable, data-driven model for early hypertension detection.
How can families participate?
Parents are important members of their child’s healthcare team. If your child has a condition putting them at high risk for high BP, remind your pediatrician to check their BP at every well visit. Parents can help the team get accurate BP by working alongside the clinical team to keep their child comfortable. Blood pressure measurements are only accurate when a child is comfortable and calm. If your child is less than 3 years old, you can keep them in your lap (or another comfortable position) while their BP is measured in their right arm. The goal is for the child to be happy, warm and cozy. Distract your little one with a bottle, a toy or a video. Identifying a problem early can help your child get the care they need that will support their health as they grow.
How can pediatricians support the initiative?
Pediatricians can support the initiative by adopting standardized BP measurement practices for high-risk children under 3 and integrating them into routine care. Through participation in BP Under 3, providers can improve early detection of hypertension, ensure appropriate evaluation and treatment, and strengthen long-term cardiovascular outcomes for vulnerable children. If a provider is interested in participating in BP Under 3, please reach out via email at BPunder3@chop.edu.
What role does the Magical Mila Foundation play?
Mila Roomberg was diagnosed with neurofibromatosis type 1 (NF1), a genetic condition that can affect the nervous system and blood vessels, when she was approximately two months old. NF1 is associated with vasculopathy, a disorder of blood vessels that can lead to hypertension.
Mila developed severe vascular complications, including mid-aortic syndrome – a significant narrowing of the aorta near the diaphragm – and narrowing of both renal arteries. Because blood pressure measurement in very young children is technically challenging, her hypertension was not detected until she was 14 months old.
During a sedated MRI, Mila's medical team took her blood pressure and it was an alarming 240/110 mmHg. Because of the severity of her condition, Mila required complex vascular surgery, as medication alone was insufficient to control her blood pressure. Tragically, she died from complications related to the extensive procedure.
In the aftermath of Mila’s death, her parents poured their overwhelming grief into founding the Magical Mila Foundation, which advances awareness, improves early detection of hypertension in young children and results in advanced clinical care for children, improving their long-term outcomes.
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Checking blood pressure in young children isn’t something most families think about. But early, accurate screening can make a big difference for kids at risk of high blood pressure (hypertension).
CHOP's BP Under 3 Initiative helps to ensure these children get their blood pressure checked during regular visits, so any concerns can be identified and treated sooner.
With better tools, training and reminders, our medical team makes blood pressure checks a simple, routine part of care for the kids who need it most. It’s another proactive way CHOP helps to protect long-term heart, kidney and brain health, setting your child up for a healthier future.
What is the BP Under 3 initiative?
BP Under 3 is a clinical and quality improvement initiative that improves early detection of high blood pressure (BP) in children younger than 3 who are at increased risk of hypertension. The program promotes consistent, accurate, and routine BP measurement in primary and specialty care settings, establishing a new standard of pediatric care.
Developed by the Children’s Hospital of Philadelphia in collaboration with the Magical Mila Foundation, the initiative aims to scale this model locally, nationally and globally. Earlier diagnosis supports healthier futures for children through improved screening, coordinated care and tracked clinical outcomes.
Why is measuring blood pressure important for children under 3?
Blood pressure measurement in young children is critical because hypertension can be present early. If it goes unnoticed and untreated, it can cause serious organ damage. Early and accurate BP measurement allows the clinical team to identify true hypertension, initiate timely evaluation and treatment, and prevent long-term complications that affect the brain, heart and kidneys.
However, it can be difficult to obtain accurate BPs in children under three years. Challenges include the limitations of device technology, poor identification of the children who are most at risk, the clinical difficulties of measuring BP in infants, and a lack of appropriate education with the clinical team.
Who can benefit from this initiative?
BP Under 3 benefits children younger than 3 who are at increased risk for hypertension because of underlying medical conditions. Children face a higher risk if they have one of the following conditions:
- Congenital heart disease
- Renal disease
- Solid-organ transplant
- Bone-marrow transplant
- Various neonatal issues (low birth weight, less than 32 weeks' gestation, use of umbilical artery lines, ECMO)
- Many conditions and syndromes such as Alagille, Turner, Williams, and neurofibromatosis type 1
Collectively, this group represents 5% to 6% of the pediatric population seen in primary care.
How does the program work?
The 2017 American Academy of Pediatrics guidelines recommend BP measurement in children under 3 only when they are at increased risk for hypertension. Prior to this program’s implementation, providers did not have a reliable approach to identify these high-risk children at their well visits. BP Under 3 addresses this gap by systematically identifying high-risk children at their well visits and standardizing BP measurement in routine care.
BP Under 3 provides a comprehensive package of clinical tools and infrastructure, including:
- An Epic-based alert that flags high-risk children before and during well visits, prompting the clinical team to obtain a blood pressure measurement. This ensures consistent screening for children who meet high-risk criteria at their pediatrician visits who otherwise would have been missed.
- Widespread staff education on accurate BP measurement techniques in infants and toddlers.
- Distribution of ID badges summarizing key measurement principles and age-specific BP normative values.
- Webinars, educational sessions and hands-on training for clinical staff.
- Toolkits with posters and reference materials for exam rooms outlining best practices and protocols.
- A real-time electronic dashboard to track BP measurement rates, enable data analysis and identify opportunities for quality improvement.
Together, these components embed BP measurement into routine care for high-risk children under 3 and create a sustainable, data-driven model for early hypertension detection.
How can families participate?
Parents are important members of their child’s healthcare team. If your child has a condition putting them at high risk for high BP, remind your pediatrician to check their BP at every well visit. Parents can help the team get accurate BP by working alongside the clinical team to keep their child comfortable. Blood pressure measurements are only accurate when a child is comfortable and calm. If your child is less than 3 years old, you can keep them in your lap (or another comfortable position) while their BP is measured in their right arm. The goal is for the child to be happy, warm and cozy. Distract your little one with a bottle, a toy or a video. Identifying a problem early can help your child get the care they need that will support their health as they grow.
How can pediatricians support the initiative?
Pediatricians can support the initiative by adopting standardized BP measurement practices for high-risk children under 3 and integrating them into routine care. Through participation in BP Under 3, providers can improve early detection of hypertension, ensure appropriate evaluation and treatment, and strengthen long-term cardiovascular outcomes for vulnerable children. If a provider is interested in participating in BP Under 3, please reach out via email at BPunder3@chop.edu.
What role does the Magical Mila Foundation play?
Mila Roomberg was diagnosed with neurofibromatosis type 1 (NF1), a genetic condition that can affect the nervous system and blood vessels, when she was approximately two months old. NF1 is associated with vasculopathy, a disorder of blood vessels that can lead to hypertension.
Mila developed severe vascular complications, including mid-aortic syndrome – a significant narrowing of the aorta near the diaphragm – and narrowing of both renal arteries. Because blood pressure measurement in very young children is technically challenging, her hypertension was not detected until she was 14 months old.
During a sedated MRI, Mila's medical team took her blood pressure and it was an alarming 240/110 mmHg. Because of the severity of her condition, Mila required complex vascular surgery, as medication alone was insufficient to control her blood pressure. Tragically, she died from complications related to the extensive procedure.
In the aftermath of Mila’s death, her parents poured their overwhelming grief into founding the Magical Mila Foundation, which advances awareness, improves early detection of hypertension in young children and results in advanced clinical care for children, improving their long-term outcomes.
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