Hypertension has increased in the pediatric population, in part because of the increase in childhood obesity. Unlike hypertension in adults, hypertension in children is not defined by an established cutoff point. Like BMI, the definition of childhood hypertension is defined based upon the normative distribution of blood pressure in healthy children. Blood pressure percentiles are based on gender, age, and height. Hypertension is diagnosed after elevated measurements are noted on three separate occasions.

Metabolic Syndrome

Pediatric practitioners also need to have an increased awareness for metabolic syndrome. This syndrome comprises a group of risk factors that indicates an increase in the risk for developing type 2 DM and premature cardiovascular disease in adults (5,6). The concept that insulin resistance and associated metabolic abnormalities, including lipid and blood pressure abnormalities and type 2 DM, increase the risk of atherosclerotic cardiovascular disease in adults was first proposed by Reaven in 1988 at the American Diabetes Association’s annual meeting (7).

BMI Categories

The importance of clinically identifying children with severe obesity is increasing, as these children are at particularly high risk for medical and probably psychological complications and may need to be specifically targeted for treatment. Pediatric practitioners can use the 99th percentile BMI cutoff points listed in Table 2. These are not included on the current growth charts.

Table 2. 99th Percentile BMI Cutoff Points According to Age and Gender

Diagnosis Overview

Body Mass Index

Body Mass Index (BMI) is an indirect way to assess body fat and is calculated by dividing weight by height squared (1). In a clinical setting BMI is a useful tool in assessing children’s weight status, but additional clinical information is useful in making the diagnosis of obesity. For children aged 2 to 20 years, age- and gender-specific references for BMI exist. They were included in the 2000 CDC Growth Charts, which are widely used in clinical practice and are available at www.cdc.gov/growthcharts.


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