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High Altitude Pulmonary Edema in Children

High Altitude Pulmonary Edema or HAPE is a condition where a person’s lungs fill with up with fluid. This is normally attributed to a change in altitude and pressure which causes your heart and lungs to work abnormally.  We often think of this as only occurring in people who live at a low altitude coming to a higher altitude, but there is a version called "Re-Entry" HAPE.

When children raised at elevation are taken to a lower elevation then re-enter a high elevation a condition known as re-entry HAPE can occur. This condition does not typically occur in adults, and most children will grow out of it by the time they reach eighteen. It is most often seen in the middle teen years.  While rare, it is probably more common than we realize and can be associated with underlying congenital heart issues.

A study was conducted at St. Vincent Hospital in Leadville in the 1970s. This condition was found to have an incidence rate of 140 per 100,000 people aged one to fourteen years old. The study, High-Altitude Pulmonary Edema in the Children and Young Adults of Leadville, Colorado, found that 93 percent of these cases were in local, Leadville children. This study found that affected children spent as little as twenty-four hours at a low altitude. They also found that all these children complained of symptoms within one to three days after reascent.

To prevent re-entry HAPE it is recommended that your child avoid physical activity, drink plenty of fluids and avoid alcohol when you return to altitude from visiting a lower elevation. Symptoms include shortness of breath, a cough that occurs 12-48 hours after returning to elevation as well as a low-grade fever that also occurs 12-48 hours after returning. If your child is experiencing any of these symptoms, we recommend getting examined by a physician. As mentioned above, this could be indicative of an underlying issue. Make sure your child rests and does not try to just push through any symptoms. If they start to experience breathing issues, they should visit the emergency department.  

If your child has experienced re-entry HAPE in the past, it is possible to prescribe them medication to ease the effects of returning to elevation. You can also treat the child with oxygen and avoid physical activity for at least 24 hours. Re-entry HAPE seems to be more common if the child exercises right after returning to elevation.  

If you have any concerns or questions, contact your primary care physician for clarification.