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Approaches to Disease Management

         Hypertension is a significant issue affecting many children and adolescents. School-age children are found to have high blood pressure (BP) linked to obesity, sedentary lifestyles, and stress. In infants, hypertension is secondary to other processes, such as renovascular or parenchymal renal diseases, endocrine disorders, genetic illnesses, and coarctation of the aorta (Feber & Ahmed, 2010). Regardless of etiology, hypertension in children leads to considerable end-organ damage resulting in significant cardiovascular morbidity and mortality later on in life. Therefore, an early diagnosis and proper management may prevent hypertension-related complications even in adulthood.

Workup

        The child’s clinical workup seeks to identify whether the hypertension is primary or secondary. It must assess possible underlying causes of the condition, detect comorbid disorders, and establish the presence of any target end-organ damage. History of prolonged mechanical ventilation, umbilical catheterization, prematurity, or small gestational age at birth should be recorded (Burns et al., 2017). Additionally, the physician should probe the mother concerning poor maternal nutrition and high-stress levels, which affect the embryo epigenetically, making hypertension more likely to occur in the child. Further, there is a need to ask about chronic diseases, such as renal diseases and urinary tract infections, in the child. The physician should also enquire about any heritable conditions in the family. Physical examination should note elevated BP on at least three separate occasions, gross hematuria, and edema.

Differential Diagnoses

         When evaluating the 3-year-old patient for hypertension, it is reasonable to initially consider common etiologies, for example, renal parenchymal illnesses, renovascular diseases, and congenital abnormalities. However, various uncommon processes can also cause hypertension in the child (Burns et al., 2017). History of edema or previous urinary tract infection may indicate renal disease.

Assessment

         In this case, the 3-year-old patient has already had three documented high BP cases confirming hypertension diagnosis. Various laboratory tests, for example, erythrocyte sedimentation rate (ESR), C-reactive protein (CPR) tests, electrolytes levels, urinalysis, and ultrasound should be used to assess other conditions that could be causing the illness (Burns et al., 2017).  Additional organ assessments, such as echocardiography for aorta coarctation and left ventricular hypertrophy (LVH), alongside in-depth ophthalmologic examinations are also to be conducted.

Management

         The most outstanding management for the hypertensive child is directed at correcting any underlying causes, monitoring, and controlling BP. Clinical decisions concerning the start and choice of therapy depend on the BP level, end-organ damage, comorbid conditions, and related risk aspects (Feber & Ahmed, 2010). Medication management commences with a single drug, for example an ACE inhibitor, at the lowest recommended dose, which is increased until the desired BP is attained. If a maximum dose is reached, a second medication should be added.

Care Plan for 10-Year-Old Child

         A 10-year-old child may require a care plan different from that of a 3-year-old infant. Moreover, older children may experience primary hypertension due to the rise in obesity rates. Nevertheless, physicians always consider the genitourinary system’s influence (Burns et al., 2017). If the infant has hypertension secondary to overweight, treatment should comprise nonpharmacologic interventions, such as diet, exercise, and weight management.

         Counseling would emphasize both behavioral change and parental involvement. Reducing the child’s body mass index (BMI) and heightening aerobic fitness would be recommended since it has been shown to minimize elevations in age-related BP (Kaelber et al., 2016). Additionally, good nutrition with a decline in dietary fat and sodium as well as caffeine avoidance would be advised (Burns et al., 2017). For example, the child should not have more than 1,500 milligrams of salt a day. Further, I would encourage minimal prescription of medications that can elevate BP, such as cold medicine with ephedrine.

         An early hypertension diagnosis and proper management may prevent complications, such as end-organ damage and mortality. In the absence of findings that might suggest other causes, it is advisable to start secondary hypertension evaluation in children by focusing on renovascular or renal diseases. Hence, management can be directed at correcting any underlying causes, monitoring, and controlling BP. However, for older children, a different care plan, encompassing nonpharmacologic interventions, such as diet, exercise, and weight management, should be implemented.

References

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Maaks, D. L. G. (2017). Pediatric Primary Care-E-Book. Elsevier Health Sciences.

Feber, J., & Ahmed, M. (2010). Hypertension in children: New trends and challenges. Clinical Science, 119(4), 151-161.https://www.researchgate.net/profile/Janusz_Feber/publication/44606798_Hypertension_in_children_New_trends_and_challenges/links/56b21b1508aed7ba3fedb7f5/Hypertension-in-children-New-trends-and-challenges.pdf (Links to an external site.) (Links to an external site.)

       Kaelber, D. C., Liu, W., Ross, M., Localio, A. R., Leon, J. B., Pace, W. D., & Fiks, A. G. (2016). Diagnosis and medication treatment of pediatric hypertension: A retrospective cohort study. Pediatrics, 138(6).https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127074/ (Links to an external site.) (Links to an external site.)