Cuff-associated errors of blood pressure recording in infants and toddlers.

As commercially available cuffs are unsatisfactory, systolic blood pressure (BP) was measured in 88 children aged less than 4 years using a conventional Velcro self-adhesive cuff with inflatable bladder. Results were compared with the "separate bladder" method (where the inflatable bladder is wrapped around the arm and is held by a separate Velcro-band), the Pedisphyg cuff and, in 10 patients, with intra-arterial recording. The last 3 methods gave nearly identical results. In contrast, conventional cuffs with a 4 cm and a 5.5 cm wide bladder considerably over-estimated systolic BP, by 13.3 mm Hg (range -2 to 30) for bladder width 4 cm, and by 13.1 mm Hg (range 4 to 22) for bladder width 5.5 cm, respectively. The conventional bladder-cuff thus yields grossly inaccurate results in young children and should be replaced by an alternative method, e.g. the "separate bladder".