Late last week, The American Academy of Pediatrics (AAP) published a 43 page expert panel report addressing ways to reduce risk from cardiovascular (heart) disease beginning with interventions in childhood. The panel report is based on a huge review of current medical evidence, yet the press focused mostly on 1 sentence from the thick report:
All children should be screened for high cholesterol (via a blood test) at age 9-11 years and then again between 17 -21 years of age.
And although the recommendation for cholesterol screening is a huge one and represents a major shift in pediatric screening, the other 42 plus pages were loaded with additional wisdom founded in science. I’m doing my best to make sense of all the recommendations but as I get more overwhelmed by the sheer quantity of information in the report, I’m taking the advice of my husband, “Effective communication [about this report] lies somewhere between a tweet and those other 42 pages.”
Most primary care docs simply won’t have time to read the entire report but will likely incorporate the recommended changes into practice. And because heart disease kills more men and women than any other medical problem in our country, learning how to protect our children/prevent heart disease remains an essential part of my job description. Yours, too.
Remember, screening isn’t designed only to determine which children will need cholesterol-lowering medications (only about 1%), it is designed to ascertain which children are at risk for developing heart disease. And which children can benefit from major lifestyle changes now that will ultimately prevent it.
Great opportunity lies within each one of our children. Countless opportunities for wonder and health, contribution and happiness, love and contentment. Every parent knows this on day one. How we can reduce risks for our children and help them live long, happy, and healthy lives? Preventative care is as good as it gets. I’ll summarize a few highlights from the lengthy, dense report that will help you talk with your child’s pediatrician and hopefully help remind you what we can all do to support our children as we work to avoid heart disease.
Atherosclerotic cardiovascular disease (CVD) remains the leading cause of death in North Americans, but manifest disease in childhood and adolescence is rare. By contrast, risk factors and risk behaviors that accelerate the development of atherosclerosis begin in childhood, and there is increasing evidence that risk reduction delays progression toward clinical disease.
Risk Factors For Cardiovascular Disease (CVD)
Risk factors for cardiovascular disease must be addressed during childhood well child visits. Acknowledging risks for heart disease early in your child’s life can change the screening we do and ultimately may prevent or stave off heart disease. Here are a few to consider:
- Family history. If your child has a parent, grandparent, sibling, uncle or aunt with CVD (heart attack, coronary catheter intervention, stroke, sudden death) before age 55, your child may be at higher risk for heart disease later in life. Talk to your child’s pediatrician if there is a family history of heart disease.
- Cholesterol level matters. Knowing a child’s cholesterol is elevated may help you intervene to avoid life-long elevated cholesterol that can change the blood vessels in your child’s heart and lead to heart disease. At age 9 to 11, it is recommended that your child have a cholesterol screen (independent of risk factors). If your child has a parent with high cholesterol (total cholesterol over 240) or has a close relative who has had a stroke or heart attack prior to age 55, your child will need a cholesterol level checked twice prior to age 9.
- High blood pressure. Children with high blood pressure have been found to have an increased risk of developing heart disease. Your child should have a blood pressure check every year at their check up starting at 3 years of age. Of note, in children (as opposed to adults) the normal blood pressure range depends on gender, age, and height. A normal blood pressure at age 3 is not the same as a normal blood pressure at age 10 and they are not the same between girls and boys. At the well child check up, ask the pediatrician if your child’s blood pressures is in the normal range for your child specifically.
- Diabetes increases the risk of heart disease. If your child has diabetes, they need to be screened more carefully for heart disease. Additionally, some children should be screened for diabetes (blood glucose level) if they are overweight and have a strong family history of diabetes. Ask your child’s clinician if you are concerned about your child needing a screening blood test or they have a strong family history of diabetes.
- Obesity. Being overweight and obese increases the likelihood for developing heart disease. If your child is overweight, talk with their clinician about what additional screening is necessary and ongoing ways to work on weight reduction as they grow and grow!
Diet Matters From Day One
The expert panel concluded that “there is strong and consistent evidence that good nutrition beginning at birth has profound health benefits and the potential to decrease future risk” of heart disease.
- You have heard over and over and over again that breastfeeding is best. Yup, and it has been found in long-term studies to benefit children and their heart for a lifetime including lowering cholesterol levels, having lower weight, and lower prevalence of type 2 diabetes. When possible, it’s recommended to breast feed your baby up to 1 year of age with 6 months of exclusive breast milk at the start. If you’re having trouble, just take one day at a time. If you weren’t able to breast feed your baby, focus on what you can do from here forward. As a mom to two boys (one nearly exclusively breast fed, one that I wasn’t able to breast feed as long as I would have liked) I know how hard it is to hear this again and again and agonize retrospectively. If you weren’t able to breast feed, stop beating yourself up…
- Limit fat to 30% of your child’s total calories after 2 years of age. We are all given this same recommendation as adults. Translation: your child should eat a diet similar to your own after age 2, one with limited calories from fat. As a start, after age 2 stop offering whole milk and aim to provide non-fat milk and water as their main beverages.
- Diets lower in salt lead to lower blood pressure in infants, children, and adolescents. It’s never too early to limit sodium in a child’s diet. Elevated blood pressure is a major contributor to heart disease.
- Reduce intake of sugar-sweetened beverages (soda, juice, sports drinks, flavored milk). Remember, 100% fruit juice can be a great part of a child’s diet but recommendations continue to state: No more than 4 ounces a day.
- Encourage whole foods high in dietary fiber (whole wheat bread, brown rice, oatmeal, cereal, popcorn), fresh fruits and veggies. My Plate discusses having 1/2 of your child’s plate full of fresh fruit and veggies at every meal.
Stay Away From Smoke
Tobacco smoke is a major contributor to heart disease. Tobacco dependence is responsible for 4 million deaths around the world every year. Exposure to tobacco smoke contributes to heart disease, and the committee reminded me “the evidence that cigarette use is harmful and addictive is unequivocal.” Did you know that >20% of high school students reporting smoking daily between 2003 and 2007?
- If you suspect your child is smoking, talk with them. Talk with their doctor. Don’t wait.
- If you’re smoking, consider getting serious about quitting. Call 1-800-QUIT-NOW.
Don’t Forget To Move
Sedentary activity leads to inactivity, overweight, and poor cardiovascular health. These are going to seem like no-brainers, but here you go:
- There is good evidence that physical activity patterns established in childhood are carried forward into adulthood. Translation: exercising and providing unlimited play time for your children will create lifelong habits that incorporate exercise and healthy movement. This will only help your child live longer.
- Children should be encouraged to have active play, every day.
- Limit sedentary and screen time to less than 2 hours every day for 1 to 4 year olds. Limit screen time to less than 1 hour of quality programming daily after school starts (age 5).
- Avoid EVER putting a TV in a child’s bedroom.
Recommendations To Remember:
- Screening cholesterol levels for all children at age 9-11 years of age and again at age 17 should start now. If your child has additional risk factors, screening may be recommended sooner. If cholesterol levels are elevated, talk with your pediatrician about next steps. Your pediatrician can decide if the blood draw happens at the well child visit or if a “fasting study” (a blood draw after 8 hours of no eating, ie first thing in the morning).
- Work to help your child exercise for at least 1 hour every day of their life.
- Work to keep a diet lower in fat (30% of calories from fat or less), high in fiber, and low in salt. Model good behavior. Eat together with your children. Don’t cook them separate meals. Talk with the pediatrician about other ways to improve your families’ diet.
- Go to regular well child check each year. Ask the pediatrician if the blood pressure for your child is normal. Follow up on lab testing and repeat checks.
- If you’re concerned your child may be overweight, don’t wait until the next check up. Go in and discuss ways to discuss/improve your child’s weight, diet, and activity levels now. The longer you wait, the longer you wait…
What we do for our children now matters. How we prevent and protect our children from heart disease and cardiovascular complications starts today. Atherosclerotic heart disease starts when we are children. Forty-three pages proved that careful screening and careful evaluation now may save much of our future heart ache.