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Hypotension in children is a condition characterized by a persistent or temporary decrease in blood pressure. This problem is quite relevant for children and adolescents, as it is widespread. Clinical manifestations of hypotension are very diverse, ranging from the deterioration of mental performance and ending with a sharp decrease in the quality of life.
Statistics of recent years indicate that hypotension in children is becoming more common, but in pediatric practice this problem has received very little attention. Doctors have not yet come to a consensus on how to interpret hypotension: as a syndrome or as an independent disease. So, in the medical literature it is indicated that arterial hypotension is a symptom that characterizes one or another degree of lowering blood pressure. At the same time, it would be more correct to call low blood pressure arterial hypotension, however, both in the medical literature and in the professional lexicon of doctors, the phrase arterial hypotension is firmly rooted.
WHO proposed to call the term primary hypotension or hypotension any persistent decrease in blood pressure, the cause of which is not established. In the literature, you can find such synonyms for arterial hypotension as: constitutional, primary, essential hypotension, hypotension, etc. In childhood, hypotension most often has an unstable character and a reversible course, so pediatricians rarely make a diagnosis of hypotension. It would be more correct to speak of vegetative-vascular dystonia as hypotension. However, this term implies hypotension in children.
The statistics fluctuate widely. Arterial hypotension in children varies from 3,1 to 20,9%.
Moreover, these figures grow in parallel with the increase in the age of the child and look like this:
1,2-3,1% children of primary school age;
9,6-14,3 children of senior school age.
Boys suffer from arterial hypotension less frequently than girls.
Causes of hypotension in children
The causes of arterial hypotension in children are determined by a whole complex of different components, therefore, primary hypotension is considered as a multifactorial pathology. Scientists believe that hypotension in children is based on such reasons as: hereditary predisposition, endogenous and exogenous influences.
Hereditary predisposition. Genes that would be responsible for the transmission of hypotension from parents to children have not yet been identified. However, it has been established that in those people who have a hereditary predisposition to this pathology, it is more severe. The statistics vary widely. It is believed that maternal hypotension is transmitted more often than paternal: 35-54% versus 20-23%, respectively. If a pregnant woman suffers from low blood pressure, then the risks of having a child with perinatal pathology of the central nervous system increase. In addition, the risk of miscarriage increases.
Age. It has been established that the period of puberty is the most dangerous in terms of the development of hypotension. More often, pathology is recorded in children with accelerated physical development, as well as with a delay in physical development.
Personal characteristics. It is known that vulnerable children with a developed hypertrophic sense of duty and with high self-esteem suffer from hypotension more often and more severely. In this case, arterial hypotension is the result of a constant intrapersonal conflict.
Foci of chronic infection. The more often a child gets sick, the more chronic diseases he has, the higher the risk of developing hypotension in childhood. This is due to a violation of the reactivity of the nervous system and its vascular-motor center.
Exogenous factors:
Chronic emotional stress, prolonged stress. The more traumatic situations are created within the family in which the child grows, the higher the risk of developing hypotension.
Poor social and living conditions can affect the rate of development of pathology.
Violation of the daily routine.
Frequent stress and mental strain.
Sedentary lifestyle.
In addition, a persistent drop in pressure can occur due to serious disorders in the child’s body, due to complex diseases and malformations. But in this case, hypotension will be expected. This pathology acts as a secondary symptom of the primary disease. For example, if we are talking about massive internal bleeding, heart defects, heart failure, trauma, diseases of the endocrine system, kidney disease, diabetes, etc.
Arterial hypotension in children may be the result of taking medications, for example, with an overdose of antihistamines, antidepressants, beta-blockers, calcium antagonists, etc.
Symptoms of hypotension in children
Symptoms of hypotension in children are diverse, the clinical picture is as follows:
CNS disorders: mental deterioration, headaches of varying intensity, frequent dizziness, emotional instability. Almost all children experience problems with night rest, get tired quickly during the daytime. Headaches manifest mainly in the morning, often immediately after waking up. They proceed according to the type of attacks, they are quite intense, pulsating, with localization in the fronto-parietal region. It is possible that headaches increase when weather conditions change, in addition, they can be triggered by conflict situations.
Children suffer from memory, concentration, so they seem to be more distracted compared to their peers. Naturally, this affects school performance.
Gastrointestinal disorders: loss of appetite, feeling of heaviness and discomfort in the stomach and intestines, which cannot be associated with food intake. Often children complain of bloating, nausea, sometimes vomiting and constipation can be observed.
Disorders from the cardiovascular system: pain in the region of the heart, a feeling of one’s own heartbeat, although normally the child should not feel the work of the heart.
Children with arterial hypotension do not tolerate travel in any transport.
Perhaps a prolonged and causeless increase in body temperature to subfebrile marks.
Sometimes there may be a feeling of lack of air.
Pain in the joints and muscles is possible.
Nosebleeds, which are observed in 18% of children, are not excluded.
With severe hypotension, fainting is possible.
The most common of the described symptoms are headaches, emotional instability and fatigue. Similar complaints are present in 70-90% of young patients.
Diagnosis of hypotension in children
Diagnosis of hypotension in children begins with the collection of anamnesis with clarification of aggravating heredity and the presence of close relatives with cardiovascular diseases.
In addition, the doctor must find out the presence or absence of conflict situations in the family and at school, must assess the level of physical activity of the child.
Other methods for diagnosing hypotension include:
Monitor blood pressure throughout the day.
Conducting electrocardiography.
Conducting echocardiography.
Performing a tilt test (passive orthostatic test), during which blood pressure is measured, ECG and electroencephalography data are monitored.
Performing a test with a dosed physical activity (veloergometry).
Rheoencephalography.
Electroencephalography.
Craniography and ophthalmoscopy.
Most often, children undergo psychological testing aimed at assessing personal characteristics, determining the level of personal anxiety, etc. The doctor determines a set of diagnostic methods independently, depending on the severity of hypotension, the age of the child, etc.
Treatment of hypotension in children
Treatment of hypotension in children is selected on an individual basis. Drug and non-drug correction of pathology is possible.
Non-drug treatments include:
Optimization of the daily routine of the child. Children should rest at least 9 hours a day, the head of the bed should be raised. Be sure to spend time outdoors for at least 2 hours.
In the morning, you need to do gymnastics, and in the evening you need to stop taking hot baths.
Children with hypotension should not be exposed to the sun for long periods of time.
It is possible to engage in dynamic sports. Useful slow running, gymnastics, dancing, tennis, ice skating.
Massage visit.
You should adhere to a dietary diet with the inclusion of tonic drinks (coffee or tea) in the menu.
It is possible to prescribe diuretic herbs, including birch buds, lingonberry leaves, etc.
Of the physiotherapeutic methods, electrophoresis according to Vermel with magnesium sulfate, electrosleep, and acupuncture are recommended. This also includes mineral baths, circular showers, Charcot showers.
If non-drug methods of treatment do not allow you to achieve a positive result, then your doctor may prescribe you:
CNS stimulant drugs.
Tranquilizers.
Antidepressants.
Nootropics.
Cholinolytic drugs.
Diuretic drugs.
Nervous system stimulants.
To start medical correction, there must be certain indications, including: fainting, asthenic syndrome with severe headaches, frequent dizziness, orthostatic dysregulation.
Thus, the treatment of hypotension in children should be based on complex psychotropic and vegetotropic therapy with a mandatory individual approach in each case.