Pediatric Low Blood Pressure (Hypotension)

What is low blood pressure (hypotension) in children?

A child’s blood pressure is diagnosed as low when it drops below typical levels for their age. Blood pressure is the force of blood pushing against the walls of arteries (vessels that carry blood from the heart to the body).

Normal blood pressure for children and teens usually falls between 90/60 and 120/80, and the threshold for low blood pressure varies by age. With low blood pressure, doctors pay attention to the first number (called systolic pressure). Your child may have low blood pressure if the first number is less than:

• 60 for newborns up to age 28 days

• 70 for infants up to age 12 months

• 70 + (age in years x 2) for children from age 1 to 10 (example: 70 + (8 x 2) = 86 for an 8-year-old)

• 90 for children from age 10 to 15

What are the different types of low blood pressure (hypotension) in children?

Several types of hypotension affect children and teens. They include:

Neurally mediated hypotension

This common type of low blood pressure usually affects school-aged children and teens. It can happen when your child has been standing for a long time, is in a warm environment or has just eaten or exercised. Their heart rate and blood vessels don’t respond quickly enough, causing blood pressure to drop. Many children outgrow this type over time.

Orthostatic (postural) hypotension

This type of low blood pressure happens when your child stands up quickly from a sitting or lying position. It can make them feel dizzy or lightheaded for a few seconds until their blood pressure adjusts

Severe hypotension

This type is a sudden and dangerous drop in blood pressure. It can result from a serious infection, allergic reaction, heart problem or injury. Severe hypotension can lead to shock and needs emergency care to protect the brain and other organs.

What are the signs and symptoms of pediatric low blood pressure (hypotension)?

Signs of hypotension in children and teens can vary depending on the cause. Symptoms may include:

• Dizziness (vertigo) or lightheadedness

• Fainting

• Fatigue (tiredness)

• Blurred vision

• Nausea and vomiting

• Confusion

• Weakness

Severe hypotension can be life threatening. Some signs of dangerously low blood pressure and shock include:

• Rapid, shallow breathing

• Cold, pale or clammy skin

• Weak, rapid pulse

• Blue tint to the skin

If your child experiences any of these severe symptoms, they need emergency care right away.

How is low blood pressure (hypotension) diagnosed in children?

Your child’s doctor or provider might notice low blood pressure in your child during a routine visit. We diagnose pediatric low blood pressure with a physical exam and a series of blood pressure checks over time. We’ll also ask about your child’s symptoms, medical history and any medications they’re taking.

If needed, your child may have additional tests, such as:

• Electrocardiogram (EKG/ECG): This test measures the heart’s electrical activity and rhythm to check for problems with how the heart is beating.

• Echocardiogram: This is an ultrasound of the heart that shows its structure and how well it’s pumping.

• Blood tests: These tests can check for signs of dehydration, infection or other conditions that may affect blood pressure.

• Tilt table test: During this test, we secure your child to a special bed that moves quickly from lying flat to an upright position. We monitor your child’s blood pressure and heart rate for changes between the two positions.

What causes low blood pressure (hypotension) in children?

Low blood pressure can happen for many reasons. Common causes include:

• Dehydration from illness, heat or not drinking enough fluids

• Sudden position changes, such as standing up quickly

• Certain medications, such as those for anxiety, pain or heart conditions

• Heart rhythm problems (arrhythmias)

• Infections

• Life-threatening allergic reactions (anaphylaxis)

• Blood loss from an injury

• Alcohol use, in teens

• Nervous system conditions such as dysautonomia

How is pediatric low blood pressure (hypotension) treated?

Treatment for low blood pressure in kids depends on the cause. Some children need only simple changes such as drinking more fluids. Others may need medication or care for an underlying condition.

At Children’s Health, our pediatric specialists and providers offer complete care for children who have low blood pressure. We may recommend these changes to improve your child’s blood pressure:

• Drinking more fluids and adding salt, under a provider’s supervision

• Avoiding long periods of standing still

• Ensuring slow position changes (from sitting to standing)

Our pediatric hypotension treatment options include:

• Medications to treat conditions that are causing low blood pressure

• Adjustments to medications that cause low blood pressure as a side effect

• Compression stockings to improve blood flow

We offer emergency care to treat severe hypotension:

• Fluids given through an IV (intravenous) line, which goes into a vein

• Blood transfusion, also given through an IV

• Medications to increase blood pressure and improve the heart’s ability to pump

• Antibiotics to treat infections, such as sepsis