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Part IV: Taking Care of Special Populations in VS .NET
Part IV: Taking Care of Special Populations
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the first But that s impossible, countered the woman, I m not the mother; I m the baby s aunt Other important features in the physical examination of the child from age 1 to 18 include the following: The blood pressure is taken in both arms and both legs (I discuss how to measure a child s blood pressure earlier in this chapter) A large difference suggests coarctation of the aorta The physical appearance of the child may suggest a diagnosis of Cushing s syndrome (see 4) A round, flushed face and pigmented stretch marks may be present, for example The doctor listens carefully for humming sounds over the arteries to the kidneys and the aorta These sounds suggest obstruction to the flow of blood A careful eye examination can show any changes associated with high blood pressure The doctor carefully observes the size and feels the texture of the thyroid gland; abnormal function of this gland may be a cause of high blood pressure The doctor examines the heart for damage due to high blood pressure, particularly enlargement; he is able to feel where the left side of the heart beats against the chest He feels the abdomen for the presence of masses that suggest a tumor
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Getting help from the laboratory
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If the doctor clearly suspects a secondary cause of high blood pressure, he can order the specific lab tests I note in 4 If no clear cause is found, the doctor can order several tests to narrow the diagnosis: Examination of the urine can reveal the infection that leads to kidney damage A urine exam can also show the presence of blood and excess protein, which may indicate that the kidneys are leaking abnormally An ultrasound study of the kidneys can show the size and shape of the kidneys as well as any appearance of disease (Kidney damage is frequently the cause of secondary high blood pressure in younger children) Blood levels of chemicals that are necessary for kidney function are helpful A blood potassium level can help rule out a rare aldosterone-making tumor
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15: Handling High Blood Pressure in Children
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With a complete evaluation, a doctor can find the cause in most children If the cause is reversible (such as obstruction of a kidney artery or coarctation of the aorta), then surgery is needed The effects of irreversible causes (like a damaged kidney) can be slowed down by treating the high blood pressure with lifestyle changes and, when necessary, medication
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Beginning Treatment with Lifestyle Changes
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Lifestyle changes can control high blood pressure They may be all that s necessary to reverse high blood pressure in many children, especially older children The various steps include the following: Avoiding stress: If stress is playing a role in the high blood pressure, this must be addressed The child may need some brief therapy to deal with his fears and concerns about having a disease that none of his buddies have to deal with Choosing healthy foods: Encourage the child to follow a diet that is low in fats but has more servings of fruits, vegetables, and grains The DASH diet (see 9) lowers the blood pressure in the normal-weight child as well as the overweight child Controlling diabetes: If the child has diabetes, controlling the blood glucose can help control blood pressure Exercising: Exercise (see 12) is another key to lifelong high blood pressure prevention The child needs to understand that moving the body is as crucial to lifelong health as eating properly Some question exists about the relationship between strenuous exercise and high blood pressure in children (Find out more about exercise in the following section) Losing weight: If the child is overweight, great effort should be made to help the child lose weight by carefully evaluating the current diet and altering it Suggestions include Eliminating obvious sources of empty kilocalories like sodas Reducing sources of saturated fat and cholesterol Reducing portions of all foods to get the total kilocalorie intake low enough to produce a slow but steady weight loss Don t completely deprive the child of the joys of eating In moderation, a hamburger or pizza can fit into a diet
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