American Academy of Pediatrics 2017 Blood Pressure Guidelines for Children

Clinical Classification (AAP 2017)

The AAP defines normal blood pressure in children < 13 years as < 90th percentile for age, sex, and height. 1
Elevated blood pressure is defined as ≥ 90th percentile and < 95th percentile for age, sex, and height. 1
Hypertension is defined as ≥ 95th percentile for age, sex, and height. 1
Stage 2 hypertension is defined as ≥ 95th percentile + 12 mm Hg. 1

Auscultation remains the preferred and gold‑standard technique for measuring blood pressure in children. 1

A diagnosis of hypertension requires elevated readings on three separate occasions. 1
Ambulatory blood pressure monitoring should be performed to confirm the diagnosis and to rule out white‑coat hypertension. 1

Routine blood pressure screening is recommended only at annual preventive‑care visits for healthy children. 1
More frequent screening is advised for children with predisposing conditions such as obesity, diabetes mellitus, heart disease, or kidney disease. 1
This represents a shift from the previous recommendation of measuring blood pressure at every healthcare encounter. 1

Blood pressure reference tables are height‑specific because height influences pediatric blood pressure more than age alone; therefore, percentile tables incorporate height percentiles. 2, 1

The American Heart Association recommends normal blood pressure for a 7-year-old child to be approximately 110/66 mmHg at the 50th percentile, with values up to 117/74 mmHg (90th percentile) still considered within normal range 3
For 7-year-old boys, the 50th percentile (median/normal) blood pressure is 110/66 mmHg, the 75th percentile is 115/69 mmHg, the 90th percentile is 120/72 mmHg, and the 95th percentile is 123/74 mmHg 3
For 7-year-old girls, the 50th percentile (median/normal) blood pressure is 110/66 mmHg, the 75th percentile is 116/69 mmHg, the 90th percentile is 121/72 mmHg, and the 95th percentile is 124/74 mmHg 3

The American Heart Association suggests that daytime blood pressure values for 7-year-olds at the 50th percentile are 116/72 mmHg and at the 90th percentile are 121/80 mmHg 3
The American Heart Association suggests that nighttime blood pressure values for 7-year-olds at the 50th percentile are 100/56 mmHg and at the 90th percentile are 108/64 mmHg 3

Accurate blood pressure measurement requires proper cuff sizing, with a bladder width that is 40% of mid-arm circumference and covers 80-100% of arm circumference 4
Correct positioning for blood pressure measurement involves the child sitting quietly with their right arm resting at heart level on a solid surface 4
The average of multiple blood pressure readings provides greater accuracy 5