Evidence-based practice: non-invasive blood pressure measurement in children

Blood pressure (BP) reflects a person’s cardiovascular status. BP alterations may indicate particular diseases, response to illness, and outcomes of treatment. Systolic and diastolic BPs rose substantially in children and teenagers between 1988 and 2004 (Muntner et al, 2004). In children, hypertension is most often associated with coarctation of the aorta or renal disease; more recently it has been linked to obesity (National High Blood Pressure Education Program Working Group, 2004). For premature neonates, rapid recognition of hypotension is crucial in preventing cerebral complications (Strebor, 2005). For these reasons, BP measurement is a skill frequently performed by nurses and healthcare workers in a variety of paediatric settings. However, the variety of devices used for measuring BP and the advent of automated BP measurement has resulted in many nurses losing this valuable skill. Few nurses are aware of the potential inaccuracy of automated machines (Schell et al, 2006) and there are studies indicate a disturbing lack of clarity among practitioners about the basic recommendations for accurate BP measurement. This often results in children receiving sub-optimal care. This review aims to demonstrate the complexities of measuring BP in children, highlighting an awareness of the limitations of automated machines and provide recommendations for good practice when measuring BP in children.