Updated Pediatric Cardiovascular Health Guidelines


Recently an expert panel from NIH, with endorsement by the AAP, published and revised guidelines/recommendations for identification of risk factors and age appropriate health guidance to help prevent cardiovascular disease in adults.

The following are highlights of those recommendations.

  1. Know your Family’s Medical HistoryYour family history may predict your risk for cardiovascular related diseases in adulthood (hypertension, heart disease, stroke and elevated lipids). Premature cardiovascular disease is defined as having a close family member with cardiovascular disease before age 55 in men and age 65 in women. Youth identified with a positive family history should be screened for risk factors (see below).
  2. Establish a Zero Tolerance for a Smoke-free home Beginning at BirthSmoking continues to be the leading preventable cause of death and is highly associated with cancer, respiratory diseases and negatively interacts with all other cardiovascular related risk factors. Passive smoke exposure is a risk factor beginning in infancy. Insisting on an absolute smoke free home should be required by all parents. Smoking cessation programs of many types are widely available. Allowing children to grow up in a smoke free environment is truly a gift of life and something all of us need to be committed to!
  3. Dietary and Nutrition Considerations
    1. Infants/ToddlersBreastfeeding is best (!) and is the only nutrition source necessary in the 1st six months of life in normally growing infants. After six months, baby food can be introduced with breast feeding (or formula) continued to age 1. Between ages 1-2, a transitional diet of all food groups is encouraged with introduction of reduced-fat milk (a new recommendation) and minimal sugar based drinks (including juice).
    2. Age 2 and OverContinue to emphasize a diet that incorporates all food groups with a variety of fruits, vegetables, whole grains, lean meat/fish, reduced fat milk and milk products. The diet ideally should be low in saturated fats, trans-fats, cholesterol, salt and added sugars. Sugar-based foods and beverages are discouraged and high fiber foods are encouraged.
  4. Physical Activity and ExerciseThe new guidelines give increasingly strong evidence that routine moderate to vigorous physical activity is significantly correlated with reduction of all cardiovascular risk factors. Exercise (especially aerobic type) is strongly linked to lower blood pressure, less body fat (obesity), improved lipid levels and decreased risk of diabetes.
    1. InfancyBeginning in infancy, children should be provided with both planned and spontaneous opportunities for active play. Similarly, limit time that restrains activity and movement such as being in infant seats, swings, strollers and play pens (stroller walks may be great exercise for you but make sure your toddler can get out and run around!)
    2. Pre-schoolersEncourage active (unrestrained) play, especially outdoors. This is also a great time to expose your child to a number of exploratory/sensory activities in our environment, plus the opportunity to interact with their age group. Introducing them to nature (dirty hands and muddy feet) is a rite of passage all kids need to experience!
    3. Older youth and AdolescentsGeneral guidelines encourage physical activity daily for at least 1 hour with moderate to vigorous activity 3x/week.
    4. Older teens and Young adultsThere should be physical activity at least 3x/week with “vigorous” activity for 75 minutes or “moderate” activity 2 ½ hours weekly.
  5. Blood Lipid Testing-Universal ScreeningIt is the recommendation of the panel that all children have lipid screening performed between ages 9-11 and again between ages 17-21. This is a “baseline” recommendation. Additional testing may be indicated for higher risk situations. The rationale for universal screening is based on evidence that as many as 50% of pediatric patients with elevated lipids are missed if the screening is done based only on family history. Childhood obesity (with or without a positive family history) is, in itself, associated with dyslipidemia (an abnormal blood lipid profile) and this is an especially worrisome combination for future adult cardiovascular disease.
  6. Overweight and ObesityPediatric patients determined to be overweight or obese are at high risk to remain overweight as adults with all of the known associated sequela. Unfortunately, pediatric obesity is especially concerning in that it may “speed up” all the metabolic complications of obesity. Identification and proper management of these patients is very important and underlines the need for routine exams for everybody, no matter what their health status.

Well if you’ve read through this, congratulations!! For many of us, the updated information is not novel or unique but nevertheless serves as a reminder of what constitutes a healthy lifestyle. Lifestyle approaches we take to our infants and children establish a baseline of wellness that extends throughout our lives. We all need to take this responsibility seriously!

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