The consequences of heart disease often don't show up until someone is well into adulthood. So why should busy parents be thinking about it with their kids?
"Because it's probably way easier to prevent the development of cardiac risk factors than to try and get rid of them once they've developed," says Dr. Sarah de Ferranti, a pediatric cardiologist at Boston Children's Hospital. "Prevention really is key."
Most people don't think about risk factors during childhood, says de Ferranti, who also is an associate professor of pediatrics at Harvard Medical School. "But I think it's actually essential that we all start doing that."
According to a recent study in the American Heart Association journal Circulation, only 2.2% of 2- to 19-year-olds had "optimal" scores on a scoring system that included diet, physical activity and body mass index. And while nearly 57% of 2- to 5-year-olds had high scores, among 11- to 19-year-olds, that fell to 14%.
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Protecting a child's heart health can begin with a focus on a mother's health during or even before pregnancy, says Dr. Amanda Marma Perak, senior author of the Circulation study and a pediatric cardiologist at Ann and Robert H. Lurie Children's Hospital of Chicago. But if you have a child and you haven't been thinking about their heart health, "now is the time to start," she adds.
Perak and de Ferranti offered this advice.
It starts with eating
Healthy eating habits are crucial for heart health. They also can be challenging to figure out.
"I think first is just understanding, what is healthy food?" says Perak, who is also an assistant professor of pediatrics and preventive medicine at Northwestern University. She recently helped write an update to the scoring system for heart health now known as Life's Essential 8. It weighs eight contributors to heart health for children and adults: diet, physical activity, nicotine exposure, sleep health, body weight, blood lipids (cholesterol and other fats), blood glucose and blood pressure.
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To help families understand what makes up a healthy diet, Perak uses the Department of Agriculture's MyPlate method. It envisions a diet where half the food is vegetables and fruits, a quarter is lean protein and a quarter is whole grain, with a side of dairy.
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Be patient
For picky eaters, a light touch can pay off, de Ferranti adds. She's found it effective to serve fruits and vegetables first, when children are hungriest, "as opposed to engaging in major battle" around eating a specific amount.
It's a long game that might require exposing kids to healthy foods many times, de Ferranti notes. "Try, try, try. Try again. Be persistent."
Keep 'em moving
Exercise can start young, Perak shares. "Even for a baby, you can think about getting them active in terms of tummy time and not restricting them in carriers and highchairs for a long time."
Whether it's through a formal class or just playing at a park, physical activity should be worked into a family's schedule, de Ferranti says. But the activity should be age-appropriate and align with the child's interests.
Perak has patients who enjoy dancing or just doing simple exercises at home. Organized sports can be "super helpful," Perak adds. But if pushed too hard, they can also add stress and cut into sleep time.
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Sleep on it
A sleepy child might be less likely to be physically active or might crave unhealthy food in search of an energy burst. Poor sleep, for example, is associated with obesity in kids.
According to the AHA, the daily amount of sleep a child needs to promote healing, improve brain function and reduce the risk for chronic disease varies by age: 12 to 16 hours (including naps) for ages 4 to 12 months; 11 to 14 hours for ages 1 to 2; 10 to 13 hours for ages 3 to 5; 9 to 12 hours for ages 6 to 12; and 8 to 10 hours for ages 13 to 18.
Come up with a bedtime routine that allows time for calming activities. "There's definitely research showing that having consistency around bedtime routines is associated with getting an adequate amount of sleep in kids," Perak shares.
Kids can have high blood pressure, too
Knowing your child's blood pressure numbers is important, but measuring it in kids is tricky, de Ferranti says. The numbers for what's considered high blood pressure vary by age, height and gender.
"Your pediatrician should be your go-to for that," she adds.
Understand mental health's importance
Mental health is important to heart health, de Ferranti notes. Stressful events in childhood have been linked to unhealthy behaviors and cardiovascular problems later in life.
Over the past two years of the pandemic, de Ferranti has seen the effects of stress in real-time. "I've seen a lot of young people show up in my pediatric cardiology practice with high blood pressure or other symptomatic complaints like chest pain, heart palpitations or dizziness."
Watch your child(ren) for these and other signs of distress and ask for help if needed, according to a 2021 surgeon general's report about youth mental health that offers advice for young people, parents, professionals and educators.
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Be ready for change
As with anything related to parenting, de Ferranti says, parents need to stay alert.
A decade ago, for example, the health threat from vaping was unknown. Now, scientific evidence indicates e-cigarette use can harm cardiovascular health.
"We have to be nimble," she adds, "because the world keeps changing."
Don't be too hard on yourself
"Think about this as the long game," de Ferranti emphasizes. "There's always another day to try and have a healthier diet or get more sleep or get out there and get physically active."
She says that "all in all, it's about being generally pretty good – not perfect."
By American Heart Association
