Hypotension In Children - Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Hypotension in children

Hypotension in children is a condition characterized by persistent or temporary lowering of blood pressure. This problem is quite relevant for children and adolescents, as it is widespread. The clinical manifestations of hypotension are very diverse, ranging from a deterioration in mental performance and ending with a sharp decrease in the quality of life.

Statistics of recent years indicate that hypotension in children is increasingly common, but in pediatric practice, very little attention has been paid to this problem. Doctors have not even come to a consensus on how hypotension should be interpreted: 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 decrease in blood pressure. At the same time, low blood pressure would be more correctly called arterial hypotension, however, the phrase arterial hypotension is firmly rooted in the medical literature and in the professional lexicon of doctors.

WHO proposed to call the term primary hypotension or hypotonic disease any persistent decrease in blood pressure, the cause of which is not established. In the literature, you can find such synonyms of arterial hypotension, such as: constitutional, primary, essential hypotension, hypotonic illness, etc. In childhood, hypotension is most often unstable and reversible, so pediatricians rarely diagnose hypotonic illness. It would be more correct to talk about vegetative-vascular dystonia by the type of hypotension. However, this term refers to hypotension in children.

The statistics fluctuate widely. Arterial hypotension in children ranges from 3.1 to 20.9%.

Moreover, these numbers grow in parallel with the increase in the age of the child and look as follows:

• 1.2-3.1% are children of primary school age;
• 9.6-14.3 children of senior school age.

Boys suffer from arterial hypotension less often than girls.

Content:

• Causes of hypotension in children
• Symptoms of hypotension in children
• Diagnosis of hypotension in children
• Treatment of hypotension in children

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.

1. Hereditary predisposition. The genes that would be responsible for the transmission of hypotension from parents to children have not yet been identified. Nevertheless, it has been established that in those people who have a hereditary predisposition to this pathology, it is more severe. 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 threat of miscarriage increases.
2. 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 delayed physical development.

3. 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 strongly. In this case, arterial hypotension is a consequence of constant intrapersonal conflict.
4. Foci of chronic infection. The more often a child is 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 vaso-motor center.

5. 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.
6. Sedentary lifestyle.

In addition, a persistent drop in blood pressure can occur due to serious disorders in the child's body, due to complex diseases and developmental defects. But in this case, the 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, injuries, endocrine system diseases, kidney disease, diabetes, etc.

Arterial hypotension in children can 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 presented as follows:

• Disturbances from the central nervous system: deterioration of mental abilities, 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 seizures, are quite intense, pulsating, localized in the frontal-parietal region. It is possible that headaches intensify when weather conditions change, in addition, they can be triggered by conflict situations.
• Children suffer from memory loss, concentration of attention, so they seem to be more absent-minded 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. Children often complain of bloating, nausea, and sometimes vomiting and constipation.
• Violations of the cardiovascular system: pain in the heart, a feeling of his own heartbeat, although normally the child should not feel the work of the heart.
• Children with arterial hypotension do not tolerate travel in any type of transport.
• Perhaps a prolonged and unreasonable increase in body temperature to subfebrile levels.
• Sometimes there may be a feeling of shortness of breath.
• Joint and muscle pains are possible.
• Nosebleeds are not excluded, which are observed in 18% of children.
• With severe hypotension, fainting is possible.

The most common symptoms described are headaches, emotional instability and fatigue. 70-90% of young patients have similar complaints.

Diagnosis of hypotension in children

Diagnosis of hypotension in children begins with taking anamnesis with clarification of the 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:

• Monitoring blood pressure throughout the day.
• Electrocardiography.
• Echocardiography.
• Performing a tilt test (passive orthostatic test), during which blood pressure is measured, ECG data and electroencephalography are monitored.
• Testing with dosed physical activity (bicycle ergometry).
• 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 the set of diagnostic methods independently, depending on the severity of hypotension, the child's age, etc.

Treatment of hypotension in children

Treatment of hypotension in children is selected on an individual basis. Possible drug and non-drug correction of pathology.

Non-pharmacological methods of treatment include:

• Optimization of the child's day regimen. Children should rest at least 9 hours a day, and the head of the bed should be raised. Be sure to spend at least 2 hours in the fresh air.
• In the morning, it is necessary to carry out gymnastics, and in the evening you need to refuse to take hot baths.
• Children with hypotension should not be exposed to the sun for long periods of time.
• It is possible to practice dynamic sports. Slow running, gymnastics, dancing, tennis, skating are useful.
• Visit to a masseur.
• You should adhere to a dietary diet with the inclusion of tonic drinks (coffee or tea) in the menu.
• Perhaps the appointment of diuretic herbs, including birch buds, lingonberry leaf, etc.
• Of the physiotherapeutic methods, Vermel electrophoresis with magnesium sulfate, electrosleep, acupuncture are recommended. This also includes mineral baths, circular shower, Charcot shower.

If non-drug methods of treatment do not allow achieving a positive result, then the following drugs are recommended:

• Central nervous system stimulants.
• Tranquilizers (Grandaxin, Trioxazine).
• Antidepressants.
• Nootropics (Nootropil, Piracetam).
• Anticholinergic drugs.
• Diuretic drugs.
• Nervous system stimulants.

For the beginning of drug 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 an obligatory individual approach in each case.

The author of the article: Sokolova Praskovya Fedorovna | Pediatrician

Education: Diploma in the specialty "General Medicine" received at the Volgograd State Medical University. A specialist certificate was immediately received in 2014.