Skip to main content
SpringerLink
Log in

Physical adaptation of children to life at high altitude

  • Review
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Children permanently exposed to hypoxia at altitudes of >3000 m above sea level show a phenotypical form of adaptation. Under these environmental conditions, oxygen uptake in the lungs is enhanced by increases in ventilation, lung compliance, and pulmonary diffusion. Lung and thorax volumes in children growing up at high altitude are increased. The haemoglobin concentration in highlanders is evevated. With respect to the decreased arterial oxygen tension at high altitude, this seems a useful adaptation. Blood viscosity also increases as a result of the increase in red blood cell concentrations however, and this has potentially negative effects on the microcirculation in the tissues. The decreased partial pressure of oxygen in the lungs of highland children is associated with a higher pulmonary artery pressure. Pulmonary hypertension, high altitude pulmonary oedema, and chronic mountain sickness form part of the pathophysiology afflicting highland dwellers. Birth weight at high altitude is decreased. Decreased postnatal growth has been widely reported in populations at high altitude, particularly in early studies from the Andes. Recent studies taking into account the effects of socio-economic deprivation, suggest that long-term exposure to altitudes of 2500–3900 m is associated with a moderate reduction in linear growth in children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

c a O 2 :

anterial oxygen concentration

c Hb :

haemoglobin concentration

c vO2 :

venous oxygen concentration

2,3-DPG 2,3:

diphosphoglycerate

p aO2 :

arterial oxygen tension

pO 2 :

partial pressure of oxygen

pCO 2 :

partial pressure of carbon dioxide

Q :

cardiac output

S aO2 :

arterial oxygen saturation

S vO2 :

mixed venous oxygen saturation

VO 2 :

oxygen consumption

References

  1. Anderson RH, Shinebourne EA, Macartney FJ, Tynan F (1987) Pediatric cardiology (Vol. 1). Churchill Livingstone, London

    Google Scholar 

  2. Arias-Stella J, Saldana M (1962) The muscular pulmonary arteries in people native to high altitude. Med Thorac 19: 484–493

    Google Scholar 

  3. Aste-Salazar J, Hurtado A (1944) The affinity of hemoglobin for oxygen at sea level and high altitude. Am J Physiol 142: 733–743

    Google Scholar 

  4. Ballew C, Garruto RM, Haas JD (1989) High-altitude hematology: paradigm or enigma? In: Little MA, Haas JD (eds) Human population biology. Oxford University Press, New York, pp 239–262

    Google Scholar 

  5. Banchero N (1987) Cardiovascular responses to chronic hypoxia. Ann Rev Physiol 49: 465–476

    Google Scholar 

  6. Barcroft J, Binger CA, Bock AV, Doggart JH, Forbes HS, Harrop G, Meakins JC, Redfield AC (1923) Observations upon the effect of high altitude on the physiological processes of the human blood, carried out in the Peruvian Andes, chiefly at Cerro de Pasco. Philos Trans R Soc Lond 211: 351–480

    Google Scholar 

  7. Bartlett DL, Remmers JE (1971) Effects of high altitude exposure on the lungs of young rats. Respir Physiol 13: 116–125

    Google Scholar 

  8. Bartsch P, Maggiorini M, Ritter M, Noti C, Vock P, Oelz O (1991) Prevention of high-altitude pulmonary edema by nifedipine. N Engl J Med 325: 1284–1289

    Google Scholar 

  9. Beall CM (1976) The effects of high altitude on growth, morbidity and mortality of Peruvian infants. Pennsylvania State University, University Park

    Google Scholar 

  10. Beall CM, Baker PT, Haas JD (1977) The effects of high altitude on adolescent growth in southern Peruvian Amerindians. Hum Biol 49: 109–124

    Google Scholar 

  11. Bligh J (1976) Introduction to acclimatory adaptation-including notes on terminology. In: Bligh J, Cloudsley-Thompson JL, MacDonald AG (eds) Environmental physiology of animals. Wiley, New York, pp 219–229

    Google Scholar 

  12. Brody JS, Lahiri S, Simpser M, Motoyama EK, Velasquez T (1977) Lung elasticity and airway dynamics in Peruvian natives to high altitude. J Appl Physiol 42: 245–251

    Google Scholar 

  13. Cassin S, Dawes GS, Mott JC, Ross BB, Strang LB (1964) The vascular resistance of the foetal and newly ventilated lung of the lamb. J Physiol 171: 61–79

    Google Scholar 

  14. Cavin WH, Edwards JE (1951) The post-natal structural changes in the interpulmonary arteries and arterioles. Arch Pathol 51: 192–200

    Google Scholar 

  15. Clegg EJ, Pawson IG, Ashton EH, Finn RM (1972) The growth of children at different altitudes in Ethiopia. Philos Trans R Soc Lond 264: 403–437

    Google Scholar 

  16. Cross KW, Tizard JPM, Trythall DAH (1958) The gaseous metabolism of the newborn infant breathing 15% oxygen. Acta Pediatr 47: 217–237

    Google Scholar 

  17. Cunningham EL, Brody JS, Jain BP (1974) Lung growth induced by hypoxia. J Appl Physiol 37: 362–366

    Google Scholar 

  18. De Graf AC Jr, Grover RF, Johnson RL, Hammond JW, Miller JM (1970) Diffusing capacity of the lung in Caucasians native to 3,100 m. J Appl Phys 29: 71–76

    Google Scholar 

  19. Diaz B, Gallegos D, Murrillo F, Lenart VL, Weidman W, Goldsmith RI (1990) Disease and disability among the Aymara. In: Schull WJ, Rothhammer F (eds) The Aymara. Kluwer, London, pp 101–131

    Google Scholar 

  20. Faraci FM, Kilgore DL, Fedde MR (1984) Attenuated pulmonary pressor response to hypoxia in bar-headed geese. Am J Physiol 247: R402–403

    Google Scholar 

  21. Frappell P, Saiki C, Mortola JP (1991) Metabolism during normoxia, hypoxia and recovery in the newborn kitten. Respir Physiol 86: 115–124

    Google Scholar 

  22. Freyre EA, Ortiz MV (1988) The effect of altitude on adolescent growth and development. J Adolescent Health Care 9: 144–149

    Google Scholar 

  23. Frisancho AR (1969) Human growth and pulmonary function of a high altitude Peruvian Quechua population. Hum Biol 41: 365–379

    Google Scholar 

  24. Frisancho AR (1988) Origins of differences in hemoglobin concentration between Himalayan and Andean populations. Respir Physiol 72: 13–18

    Google Scholar 

  25. Frisancho AR, Baker PT (1970) Altitude and growth: a study of the pattern of physical growth of a high altitude Quechua population. Am J Phys Anthropol 32: 279–292

    Google Scholar 

  26. Frisancho AR, Velasquez T, Sanchez J (1973) Influence of developmental adaptation on lung function at high altitude. Hum Biol 45: 583–594

    Google Scholar 

  27. Frisancho AR, Borkan GA, Klayman JE (1975) Pattern of growth of lowland and highland Peruvian Quechua of similar genetic composition. Hum Biol 47: 233–243

    Google Scholar 

  28. Gonzales GF, Valera J, Rodríguez L, Vega L, Guerra-Gercía R (1984) Secular change in growth of native children and adolescent at high altitude: Huancayo, Peru. Am J Phys Anthropol 64: 47–51

    Google Scholar 

  29. Gould SJ, Lewontin RC (1979) The spandrels of San Marco and the Panglossian paradigm. In: Maynard Smith J, Holliday R (eds) The evolution of adaptation through natural selection. The Royal Society, London, pp 147–164

    Google Scholar 

  30. Greksa LP, Spielvogel H, Peredes-Fernandez L, Paz-Zamora M, Caceres E (1984) The physical growth of urban children at high altitude, Am J Phys Anthropol 65: 315–322

    Google Scholar 

  31. Greska LP, Spielvogel H, Paz-Zamorra M, Caceres E (1988) Effect of altitude on the lung function of high altitude residents of European ancestry. Am J Phys Anthropol 75: 77–85

    Google Scholar 

  32. Guleria JS, Pande JN, Dethi PK, Roy SB (1971) Pulmonary diffusing capacity at high altitude. J Appl Physiol 31: 536–543

    Google Scholar 

  33. Haas JD (1973) Altitudinal variation and infant growth and development in Peru. Pennsylvania State University, University Park

    Google Scholar 

  34. Heath D (1988) The pathology of high altitude. Ann Sports Med 4: 203–212

    Google Scholar 

  35. Heath D, Williams DR (1977) Man at high altitude. Churchill Livingstone, London

    Google Scholar 

  36. Hudlicka O (1984) Microcirculation. In: Renkin EM, Michel CC (eds) Handbook of physiology. American Physiological Society, Bethesda (MD), pp 165–216

    Google Scholar 

  37. Hultgren HN (1978) High altitude pulmonary edema. In: Staub NC (ed) Lung water and solute exchange (Lung biology in health and disease Vol. 7). Marcel Dekker, New York, pp 437–469

    Google Scholar 

  38. James LS, Rowe RD (1957) The pattern of response of pulmonary and systemic arterial pressure in newborn and older infants to short periods of hypoxia. J Pediatr 51: 5–11

    Google Scholar 

  39. Kashiwazaki H, Suzuki T, Takemoto T (1988) Altitude and reproduction of the Japanese in Bolivia. Hum Biol 60: 831–845

    Google Scholar 

  40. Keys A, Hall FG, Barron ES (1936) The position of the oxygen dissociation curve of human blood at high altitude. J Appl Physiol 115: 292–307

    Google Scholar 

  41. Lahiri S, Brody JS, Motoyama EK, Velasquez TM (1978) Regulation of breathing in newborns at high altitude. J Appl Physiol 44: 673–678

    Google Scholar 

  42. Lauer RM, Evans JA, Aoki M, Kittle CF (1965) Factors controlling pulmonary vascular resistance in fetal lambs. J Pediatr 65: 568–577

    Google Scholar 

  43. Makela M, Barton SA, Schull WJ, Weidman W, Rothhammer F (1978) The multinational Andean genetic and health program-IV. Altitude and the blood pressure of the Aymara. J Chronic Dis 31: 587–603

    Google Scholar 

  44. Marticorena E, Peñaloza D, Severino J, Hellriegel K (1962) Frequency of patent ductus arteriosus at high altitude. Proceedings of the Fourth World Congress of Cardiology, p. 155

  45. Meer K de, Heymans HSA (1993) Child mortality and nutritional status of siblings. Lancet 342: 313

    Google Scholar 

  46. Meer K de, Bergman R, Kusner JS, den Brinker WHP (1992) The impact of siblings' death on the nutritional status of children in Peru. Food Nutr Bull 14: 294–303

    Google Scholar 

  47. Meer K de, Bergman R, Kusner JS, Voorhoeve HWA (1993) Differences in physical growth of Aymara and Quechua children living a high altitude. Am J Phys Anthropol 90: 59–75

    Google Scholar 

  48. Monge C (1983) Hemoglobin regulation in hypoxemic polycythemia. In: Chamberlayne EC, Condliffe PG (eds) Adjustment to high altitude. National Institut of Health, Bethesda (MD), pp 53–56

    Google Scholar 

  49. Monge C, Monge C (1966) High-altitude diseases: mechanisms and treatment. Charles C Thomas Publ, Spring-field

    Google Scholar 

  50. Monge C, Qhittembury J (1982) Chronic mountain sickness and the pathophysiology of hypoxemic polycythemia. In: Sutton JR, Houston CS, Jones NL (eds) Hypoxia: man at altitude. Thieme-Stratton, New York, pp 51–56

    Google Scholar 

  51. Monge C, León-Velarde F (1991) Physiological adaptation to high altitude: oxygen transport in mammals and birds. Physiol Rev 71: 1135–1172

    Google Scholar 

  52. Mora JO, Paredes B de, Nayarro L de, Rodríguez É (1992) Mcjora del estado nutricional de los niños colombianos entre 1965 y 1989. Bull PAHO 113: 197–211

    Google Scholar 

  53. Morpurgo G, Battaglia P, Carter ND, Modiano G, Passi S (1972) The Bohr effect and the red cell 2,3-DPG and hemoglobin content in Sherpas and Europeans at low and high altitude. Experientia 28: 1280–1283

    Google Scholar 

  54. Mortola JP, Rezzonico R, Lanthier C (1989) Ventilation and oxygen consumption during acute hypoxia in newborn mammals: a comparative analysis. Respir Physiol 78: 31–43

    Google Scholar 

  55. Mortola JP, Rezzonico R, Fisher JT, Villena-Cabrera N, Vargas E, Gonzáles R, Peña F (1990) Compliance of the respiratory system in infants born at high altitude. Am Rev Respir Dis 142: 43–48

    Google Scholar 

  56. Mocre LG, Jahnigen D, Rounds SS, Reeves JT, Grover RF (1982) Maternal hyperventilation helps preserve arterial oxygenation during high-altitude pregnancy. J Appl Physiol 52: 690–694

    Google Scholar 

  57. Moore LG, Rounds SS, Jahningen D, Grover RF, Reeves JT (1982) Infant birth weight is related to maternal arterial oxygenation at high altitude. J Appl Physiol 52: 695–699

    Google Scholar 

  58. Passmore R, Robson JS (1976) A companion to medical studies. Blackwell, London

    Google Scholar 

  59. Peñaloza D, Sime F, Banchero N, Gamboa R (1962) Pulmonary hypertension in healthy man born and living at high altitudes. Med Thorac 19: 449–460

    Google Scholar 

  60. Peñaloza D, Sime F, Banchero N, Gamboa R, Cruz J, Marticorena E (1963) Pulmonary hypertension in healthy man born and living at high altitudes. Am J Cardiol 11: 150–157

    Google Scholar 

  61. Peñaloza D, Arias-Stella J, Sime F, Recavarren S, Marticorena E (1964) The heart and pulmonary circulation in children at high altitudes. Pediatrics 34: 568–582

    Google Scholar 

  62. Peñaloza D, Sime F, Ruiz L (1971) Cor pulmonale in chronic mountain sickness: present concept of Monge's disease. In: Porter R, Knight J (eds) High altitude physiology. Churchill Livingstone, Edinburgh, pp 41–60

    Google Scholar 

  63. Remmers JE, Mithoefer JC (1969) The carbon monoxide diffusing capacity in permanent residents at high altitudes. Respir Physiol 6: 233–244

    Google Scholar 

  64. Reynafarje C (1966) Iron metabolism during and after altitude exposure in man and in adapted animals (carnelids). Fed Proc 25: 1240–1242

    Google Scholar 

  65. Rosenthal A, Button LN, Nathan DG, Miettenen OS, Nadas AS (1971) Blood volume changes in cyanotic congenital heart disease. Am J Cardiol 27: 162–167

    Google Scholar 

  66. Rossi-Bernardi L, Luzzana M, Samaja M, Davi M, Dariva-Ricci D, Minoli J, Seaton B, Berger RL (1975) Continuous determination of the oxygen dissociation curve for whole blood. Clin Chem 21: 1747–1753

    Google Scholar 

  67. Rudolph AM (1970) The changes in the circulation after birth: their importance in congenital heart disease. Circulation 41:343–359

    Google Scholar 

  68. Rudolph AM, Cayler GC (1958) Cardiac catheterization in infants and children. Pediatr Clin North Am 5:907

    Google Scholar 

  69. Samaja M, Veisteinas A, Cerretelli P (1979) Oxygen affinity of blood in altitude Sherpas. J Appl Physiol 47: 337–341

    Google Scholar 

  70. Schrnit Jongbloed L, Hofman A (1983) Altitude and blood pressure in children. J Chron Dis 36:397–404

    Google Scholar 

  71. Schoene RB (1985) Pulmonary edema at high altitude: review, pathophysiology, and update. Clin Chest Med 6: 491–507

    Google Scholar 

  72. Sillau AH, Cueva S, Valenzuela A, Candela E (1976) O2 transport in the alpaca (Lama pacos) at sea level and at 3,300 m. Respir Physiol 27:147–155

    Google Scholar 

  73. Sime F, Banchero N, Peñaloza D, Gamboa R, Cruz J, Marticorena E (1963) Pulmonary hypertension in children born and living at high altitudes. Am J Cardiol 11:143–149

    Google Scholar 

  74. Sime F, Monge C, Whittembury J (1975) Age as a cause of chronic mountain sickness (Monge's disease). Int J Biometeor 19:93–98

    Google Scholar 

  75. Turetz Z, Kreuzer F, Hoofd LJC (1973) Advantage or disadvantage of a decrease of blood oxygen affinity for tissue oxygen supply at hypoxia. A theoretical study comparing rats and man. Pflügers Archiv 342:185–197

    Google Scholar 

  76. Vargas E, Beard J, Haas J, Cudkowica L (1982) Pulmonary diffusing capacity in young Andean highland children. Respiration 43:330–335

    Google Scholar 

  77. Winslow RM, Monge C, Statham NJ, Gibson CG, Charache S, Whittembury J, Moran O, Berger RL (1981) Variability in oxygen affinity of blood: human objects native to high altitude. J Appl Physiol 51:1411–1416

    Google Scholar 

  78. Yip R (1987) Altitude and birth weight. J Pediatr 111:869–876

    Google Scholar 

  79. Yip R, Binkin NJ, Trowbridge FL (1988) Altitude and childhood growth. J Pediatr 113:486–489

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Paediatrics, University Children's Hospital Het Wilhelmina Kinderziekenhuis, P. O. Box 18009, NL-3501 CA, Utrecht, The Netherlands

    K. de Meer

  2. Department of Paediatrics/ Beatrix Children's Clinic, University Hospital Groningen, Oostersingel 59, NL-9713 EZ, Groningen, The Netherlands

    H. S. A. Heymans & W. G. Zijlstra

Authors
  1. K. de Meer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. S. A. Heymans
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. G. Zijlstra
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

de Meer, K., Heymans, H.S.A. & Zijlstra, W.G. Physical adaptation of children to life at high altitude. Eur J Pediatr 154, 263–272 (1995). https://doi.org/10.1007/BF01957359

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01957359

Key words

Search

Navigation