Visual summary
Use the correct pediatric reference, confirm persistence, and let severity and organ effects determine the urgency of investigation and treatment.
Text version
Age changes the definition
For children under 13, use age-, sex-, and height-based percentiles with the AAP table’s lower absolute cutoffs. From age 13, stage 1 is 130–139/80–89 and stage 2 is ≥140/90 mmHg. An adult cutoff alone can miss hypertension in a small child.
Confirm the reading
Use a cuff sized to the arm, supported positioning, quiet rest, and a validated device. Repeat an elevated automated value by auscultation. Persistent diagnosis usually requires auscultatory-confirmed elevation at separate visits; severe symptoms or extreme readings need immediate assessment rather than routine waiting.
Use ABPM to resolve the phenotype
Pediatric ABPM helps confirm persistent hypertension and distinguish white-coat or masked patterns, especially in CKD or high-risk children. Use pediatric standards and an adequate recording; adult wake/sleep cutoffs cannot simply replace the relevant age/height framework.
Look for secondary clues
Review kidney/urinary history, birth history, medicines/stimulants, sleep symptoms, family history, and growth. Examine pulses and upper/lower limb pressures when appropriate. Younger age, severe hypertension, abnormal urinalysis, or impaired function increases concern for a secondary renal or vascular cause.
Decide when lifestyle is insufficient
Symptoms, stage 2 disease without a readily modifiable factor, LV hypertrophy, CKD/diabetes, or persistent hypertension despite lifestyle measures support medication evaluation. Work with the family on food, activity, and sleep without stigma; treatment should not wait indefinitely for weight loss.
Track organs and function
Recheck BP, growth, adherence, adverse effects, and drug-specific kidney/electrolyte labs. AAP’s usual treatment goal is below the 90th percentile and below 130/80 in adolescents; CKD may require a more specific ambulatory target under pediatric nephrology care.