It’s complicated: Identifying and treating high blood pressure in children

high-blood-pressure-chidren-heart-center

High blood pressure is notoriously difficult to detect in children. And the consequences of undiagnosed hypertension can be severe.

Sustained high blood pressure can lead to target end-organ disease, meaning long term effects on:

  • the kidney, e.g. renal insufficiency and ultimately end stage kidney disease
  • the heart, e.g. left ventricular hypertrophy and ultimately congestive heart failure

In children, “the difference between normal and abnormal blood pressure can be small, depending on factors like age, height and weight,” says Sarah de Ferranti, MD, director of the Preventive Cardiology Program at Boston Children’s Hospital.

A reading of 120/75 would be:

  • Stage two hypertension in a two-year old
  • Stage one hypertension in a seven-year old
  • Pre-hypertension in an 11-year old
  • Either normal or pre-hypertension in a 17-year old
  • A normal reading for an adult

“Not all kids with high blood pressure are overweight, but all overweight kids are at risk for high blood pressure,” adds de Ferranti. …Read More

The ups and downs of undescended testes: What pediatric providers need to know

undescended-testes-notesCryptorchidism, or undescended testes, is the most common genital abnormality in boys. Research shows one-in-100 male infants are affected, and approximately 30 percent of baby boys born prematurely.

According to Boston Children’s Hospital urologist, Michael Kurtz, MD, MPH, because testes are constantly on the move, it becomes a challenge to definitively diagnose the common urological condition.

“Testicles are mobile structures, and it is normal for a testis to move up and down over the course of a day,” says Boston Children’s Hospital urologist, Michael Kurtz, MD, MPH. “Moreover, lymph nodes can appear similar to the testis on imaging.”

Kurtz says the main challenge pediatricians face is distinguishing a retractile testis (a testicle that pulled upward by muscle) from an undescended testis. “And only the latter requires surgery,” he adds.

Notes sat down with Kurtz and discussed when and why it’s important to treat undescended testes early, common misconceptions, and when to refer to a pediatric urologist. …Read More

New study finds gun laws save lives: Q & A with lead author

firearm-safety

Firearm legislation is a contentious issue in this country. But researchers at Boston Children’s Hospital hope their new study may help shed some light on the topic. The narrative review, published in the November 14 issue of JAMA Internal Medicine found that stronger firearm laws are associated with reductions in firearm homicide rates.

Notes sat down with lead author Lois Lee, MD, MPH, of Boston Children’s Hospital’s Division of Emergency Medicine and Harvard Medical School to discuss the study’s findings and the implications of firearm safety on pediatric practice.

Q: What was the main takeaway of your study?

Lee: Overall, we found evidence that stronger firearm laws are associated with decreased homicides due to firearms. We grouped the laws into five general categories:

  • Laws that strengthened background checks
  • Laws that curbed firearm trafficking
  • Laws that improved child safety, including child access laws, laws requiring trigger mechanisms, and laws that imposed age restrictions for gun purchases and use
  • Laws banning military-style assault weapons
  • Laws restricting firearms in public places

Specifically, the laws that seemed to have the most effect were those that strengthened background checks and those that required a permit to purchase a firearm. …Read More

Tackling kidney stones: Q&A with Boston Children’s Kidney Stone Program co-directors

kidney-stones-in-childrenIn recent years, there has been a steep and steady increase in the incidence of kidney stones in the pediatric population. Based on this increase, Boston Children’s Hospital established a pediatric Kidney Stone Program in 2007 to help manage the influx.

Caleb Nelson, MD, MPHBartley Cilento, MD, MPH, and Michelle Baum, MD, program co-directors, discuss why kidney stones are becoming more common in children. 

How has your patient volume grown?

Dr. Nelson: A few years ago, we’d see a new patient about once a month. Now our team sees new cases every week. We have four Kidney Stone Clinics each month: two in Boston, one in Waltham and one in Weymouth. We also have a new location at our North Dartmouth satellite where we hold clinic regularly.

What do you think is causing this increase?

Dr. Nelson: There may be a number of reasons. Children are getting less physical activity, which is contributing to an increased incidence of obesity. Obese people are more likely to get stones, although both obese and non-obese children and adults can get them. We don’t know if obesity itself causes stones, or if obesity is just a marker for other factors that cause stones. Diet is a factor, as many children eat too much salt and highly processed foods and don’t drink enough water. Stones form when there’s too much of the stone-forming material and not enough water in the urine, so dehydration is a major contributor. …Read More