The Estimation of Blood Pressure in Childhood with Special Reference to the Choice of Standard Cuffs

In adults the sphygmomanometer gives blood pressure readings similar to those obtained directly with a canula in the artery (Steele, 1942) provided that the inflatable cuff used is of suitable dimensions, i.e., 12 cm. broad (von Recklinghausen, 1901). Smaller cuffs yield high readings (Gumprecht, 1900; Janeway, 1909; Phipps, 1915; Day, 1939) especially in high tension pulses (Hutchison and Rainy, 1924) and broader cuffs may give low readings (Cook, 1903; Robinow, Hamilton, Woodbury and Vopitto, 1939). The length of the cuff in relation to the circumference of the arm is a matter on which opinions have differed and is probably of much less significance. In view of the wide variation in the size of children's arms difficulty has been experienced in obtaining agreement on the most suitable dimensions for standard children's cuffs. Nicholson (1915) recommended for children of 4 to 8 years a cuff 9 cm. broad and for children 8 to 15 years one 13 cm. Robinow et al. (1939) recommend a cuff 2-5 cm. broad for the newborn, 5 cm. for small children, and 9 cm. for older children. The Arnerican Heart Association (1951) recommends cuffs 8-9 cm. for older children under 9 years, 5-6 cm. for children under 4 years, and for infants under I year 2-5 cm. Taussig (1940) suggests that the breadth of the cuff should be two-thirds the length of the upper arm. This appears to be generally accepted by paediatricians in Britain. Although certain writers (Day, 1939; AllenWilliams, 1945) have folded the rubber bag within the cuff in such a way as to adjust its breadth to the size of the arm, the method is not convenient in clinical practice where it is usual to employ cuffs of standard sizes. In this country there are available three standard sizes of cuff, namely 1 in. (2-5 cm.), 2 in. (5-0 cm.) and 4 in. (10 cm.) in breadth. The adult cuff measures 5 in. (12-5 cm.).* It is the