Journal Club: A better BP table, choosing your rehydration method, and weight stereotypes

August 1, 2009

Reviews of three pediatric articles: a quicker way to evaluate a child's blood pressure, giving parents a choice of oral or IV fluids for their kids, and a study on early weight-based stereotyping.

HIGH BLOOD PRESSURE

New tool simplifies hypertension screening

To develop their table, authors used the lower limit of height (5th percentile) in the abnormal blood pressure range (≥90th percentile) for a given gender and age. Also, if the 90th percentile was ≥120 mm Hg for systolic blood pressure or ≥80 mm Hg for diastolic blood pressure, they used 120/80 mm Hg instead because the Fourth Report considers either of these figures at least prehypertensive (Kaelber DC et al: Pediatrics 2009;123:e972).

(Look for a Q&A and podcast in October's Contemporary Pediatics with the author of the simplified BP norms.)

COMMENTARY

In 2007, members of this same group of investigators published data from a review of medical records from over 14,000 children 3 to 18 years old (Hansen ML et al: JAMA 2007;298:874). Of note, 507 (3.6%) of the children had medical record evidence of hypertension or prehypertension, but 74% went undiagnosed. The problem was not that BPs went unmeasured; only 6% of health maintenance visits failed to document it. Instead, the problem may have been that providers did not recognize that the documented BPs were abnormal. This failure is not hard to understand as BP norms for children are adjusted for gender, age, and height percentile.

In the current article, the authors propose using a vastly simpler set of BP norms for screening. Children who fail the screen would be checked against the height-adjusted norms. In this second step, a few BP screens would be found to be false positives, but the chart is designed to provide 100% sensitivity (no false negatives). This method makes a lot of sense, especially for BP measurements done in a setting where height measurements are not available. -MB

WEIGHT-BASED STEREOTYPING STARTS EARLY

Investigators presented 1,409 10-year-old boys and girls with a questionnaire that included figure drawings of boys and girls of different body sizes, ranging from thin to obese. Participants were asked to choose positive and negative adjectives that applied to the three body types. They chose from a list of 21 adjectives, such as kind, good, sloppy, stupid, and hard working. Each child rated both sexes.

The children were generally positive in their judgment of average body size, with fewer than 10% attributing negative stereotypes to it. Rather, the obese figure tended to be characterized by negative adjectives-slow, lazy, lonely, and different. Almost 60% of respondents reported relatively more negative than positive adjectives for obese figures, compared with 36% of respondents for thin figures and only 3% for average figures. The participants' own body sizes did not seem to influence their judgments on the figures' body size, though socioeconomic (SES) level did. Children at a high SES level were more likely than those of a lower level to have more negative than positive attitudes about obesity (Hansson LM et al: Acta Paediatrica 2009;98:1176).

COMMENTARY

I find this a little disheartening, especially because even obese children described obese figures more negatively. Changing these attitudes would require a new approach by marketers, the media, parents, teachers, and the children's peers. -MB