Although the theory behind measuring blood pressure in children is well known, in practice it is rarely done. One review stated that “measurement of blood pressure is now firmly established as an important component of the routine paediatric physical examination,”1 but studies in practice prove otherwise. In the United States and Australia, between 5.3% and 66% of children attending emergency departments had their blood pressure measured,2 3 4 and in the United Kingdom this figure was about 9%.5 It is almost automatic to measure blood pressure in adults in the emergency department, so why are we so bad at doing this in children?

Firstly, measuring blood pressure in children is more difficult than in adults—for example, readings are likely to be falsely high in crying toddlers, normal ranges for blood pressure are often not displayed on the clinic wall, and an appropriately sized cuff may not be available in the triage room. Secondly, if a child is in shock, capillary refill time is easier and quicker to measure and, …