Paediatricians and nurses may be missing the development of hypertension and its serious consequences even when they read a child's blood pressure, warn researchers.
The American Academy of Paediatrics (AAP) guidelines call for regular BP checks in children three years and older to screen for elevated BP.
They say elevated BP on three consecutive medical visits qualifies as hypertension.
Even a single episode of high BP can indicate hypertension and should trigger repeat measurements during the visit and subsequent doctor visits, the AAP says.
The problem is that measuring a child's BP is far more complicated than it is in adults and requires interpreting each individual measure against a reference table for age, gender and height, says lead investigator Tammy Brady, nephrologist at Hopkins Children's Hospital in the US.
Researchers at Hopkins analysed 2,500 records of visits to the paediatrician's office. Medical staff did not check BP in 500 cases.
Elevated BP scores were recorded in 726 cases of the 2,000 measurements taken, but the implications went unrecognised and unremarked upon in 87 percent of them, the study found.
The findings underscore the need for better recognition and aggressive monitoring of all children to prevent both the short-term and long-term complications of hypertension, the investigators say.
The study found that medical staff were more likely to miss elevated BP in children of normal weight and in those without a family history of cardiovascular disease.
The same was true for those children whose blood pressure was at or below 120/80, a score considered ideal in adults, but one that may portend trouble in a child, depending on height, gender and age, said a Johns Hopkins release.
Hypertension, defined as persistently elevated BP, can cause kidney, eye and heart damage. While some complications take years and decades to develop, certain ones evolve quickly, the researchers say.
These findings were published in Paediatrics.