[Show abstract][Hide abstract] ABSTRACT: Hypertensie komt vaak voor bij kinderen met overgewicht (4-14%) en obesitas (11-24%). Van de kinderen met ernstige obesitas heeft zelfs 50% hypertensie. Hoewel hypertensie meestal symptoomloos verloopt, leidt het tot cardiovasculaire ziekten en nierinsufficiëntie. De jeugdgezondheidszorg in Nederland bereikt 90-95% van de kinderen op verschillende leeftijden en vormt daarmee een unieke setting voor preventie en vroegsignalering van ziekten. Het screenen op hypertensie van kinderen met overgewicht (selectieve preventie) in de jeugdgezondheidszorg om latere cardiovasculaire en nierschade te voorkomen, wordt daarom sinds kort aanbevolen in de JGZ-richtlijn Overgewicht. Dit artikel is een onderbouwing van dit advies.
Indien kinderen met overgewicht en obesitas hypertensie hebben, zal in eerste instantie verandering in leefstijl geadviseerd worden: meer bewegen in combinatie met gezonde voeding en een eventuele zoutbeperking. Indien dit beleid onvoldoende succesvol is, zal een antihypertensivum voorgeschreven worden.
[Show abstract][Hide abstract] ABSTRACT: Children present to general practitioners with a wide range of problems, but most of the time they are not particularly unwell. Children with a more serious illness often compensate very well initially, so there is a risk that their illness will be overlooked or underestimated.
To outline the early recognition and management of children who are seriously ill.
The initial assessment of an unwell child includes the paediatric assessment triangle: appearance, breathing and circulation to skin; primary survey that focuses on basic life support, patient assessment and immediate management; secondary survey with a detailed history of the event and physical examination; and ongoing assessment. Medical practitioners and their clinic staff must be prepared to undertake initial emergency management of a seriously ill child, and they must have the equipment and supplies available to carry out that management effectively.
Australian family physician 05/2010; 39(5):270-5. · 0.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although screening for elevated blood pressure (BP) in adults is beneficial, evidence of its beneficial effects in children is not clear. Elevated BP in children is associated with atherosclerosis early in life and tracks across the life course. However, because of the high variability in BP, tracking is weak, and having an elevated BP in childhood has a low predictive value for having elevated BP later in life. The absolute risk of cardiovascular diseases associated with a given level of BP in childhood and the long-term effect of treatment beginning in childhood are not known. No study has experimentally evaluated the benefits and harm of BP screening in children. One modeling study indicates that BP screen-and-treat strategies in adolescents are moderately cost-effective but less cost-effective than population-wide interventions to decrease BP for the reduction of coronary heart diseases. The US National Heart, Lung, and Blood Institute and the European Society of Hypertension recommend that children 3 years of age and older have their BP measured during every health care visit. According to the US Preventive Services Task Force, there is no sufficient evidence to recommend for or against screening, but their recommendations have to be updated. Whether the benefits of universal BP screening in children outweigh the harm has to be determined. Studies are needed to assess the absolute risk of cardiovascular diseases associated with elevated BP in childhood, to evaluate how to simplify the identification of elevated BP, to evaluate the long-term benefits and harm of treatment beginning in childhood, and to compare universal and targeted screening strategies.
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