What parents can do to protect children from heart disease?

The effects of heart disease often don’t show up until well into adulthood. Why should busy parents think about it with their kids?

“Because it’s probably much easier to prevent the development of cardiac risk factors than to try to get rid of them once they have developed,” says Dr. Sarah de Ferranti, a pediatric cardiologist at Boston Children’s Hospital. “Prevention is really key.”

Most people don’t think about risk factors during childhood, said de Ferranti, who is also an associate professor of pediatrics at Harvard Medical School. “But I think it’s actually essential that we all do that.”

According to a recent study in the journal American Heart Association 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, that fell to 14% among 11- to 19-year-olds.

Protecting a child’s heart health can start with a focus on a mother’s health during or even before pregnancy, said Dr. Amanda Marma Perak, senior author of the Circulation study and a pediatric cardiologist at Ann and Robert H. Lurie Children’s Hospital in Chicago. But if you have a child and you haven’t thought about their heart health, “now is the time to start,” she said.

Perak and de Ferranti gave this advice.

It starts with food

Healthy eating habits are crucial for heart health. They can also be challenging to figure out.

“I think first is just understanding, what is healthy eating?” said Perak, who is also an assistant professor of pediatrics and preventive medicine at Northwestern University. She recently helped write an update to the heart health scoring system, now known as Life’s Essential 8. It weighs eight contributions 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.

To help families understand what constitutes a healthy diet, Perak uses the Department of Agriculture’s MyPlate method. It proposes a diet where half of the food consists of fruits and vegetables, a quarter of lean protein and a quarter of whole grains, with a side of dairy.

Be patient

For picky eaters, a light touch can pay off, de Ferranti said. She found it effective to serve fruits and vegetables first, when children are most hungry, “as opposed to a big fight” around eating a certain amount.

It’s a long game that often requires children to be exposed to healthy foods, de Ferranti said. “Try, try, try. Try again. Be persistent.”

Keep them moving

Exercise can start young, Perak said. “Even for a baby, you can think about getting them active in terms of tummy time and not restricting them for long in baby carriers and high chairs.”

Whether it’s through a formal class or just playing in a park, physical activity should be worked into a family’s schedule, de Ferranti said. But the activity should be age-appropriate and match the child’s interests.

Perak has patients who like to dance or just do simple exercises at home. Organized sports can be “super helpful,” Perak said. But if pushed too hard, they can also add stress and shorten sleep time.

Sleep on it

A sleepy child may be less likely to be physically active or crave unhealthy foods in search of an energy boost. Poor sleep, for example, is associated with childhood obesity.

According to the AHA, the daily amount of sleep a child needs to promote healing, improve brain function and reduce the risk of chronic disease varies by age: 12 to 16 hours (including naps) for ages 4 to 12 months; 11 a.m. to 2 p.m. for ages 1 to 2; 10 a.m. to 1 p.m. for ages 3 to 5; 9 a.m. to 12 p.m. for ages 6 to 12; and 8 to 10 hours for ages 13 to 18.

Create a bedtime routine that allows time for calming activities. “There is certainly research showing that consistency around bedtime routines is associated with adequate sleep in children,” Perak said.

Children can also have high blood pressure

It’s important to know your child’s blood pressure numbers, but measuring them in children is tricky, de Ferranti said. The numbers for what is considered high blood pressure vary by age, height and gender.

“Your pediatrician should be your go-to for that,” she said.

Understand the importance of mental health

Mental health is important for heart health, de Ferranti said. Stressful childhood events have been linked to unhealthy behaviors and cardiovascular problems later in life.

Over the past two years of the pandemic, the Ferranti has seen the effects of stress in real time. “In my pediatric cardiology practice, I’ve seen many young people show up with high blood pressure or other symptomatic complaints such as chest pain, palpitations, or dizziness.”

Parents should monitor their children for these and other signs of anxiety and seek help if needed, according to a 2021 Surgeon General’s report on youth mental health that offers advice to young people, parents, professionals and educators.

Be ready for change

As with anything related to parenting, de Ferranti said, parents need to stay alert.

Ten years ago, for example, the health threat of vaping was unknown. Now, scientific evidence shows that e-cigarette use can harm cardiovascular health.

“We have to be agile,” she said, “because the world keeps changing.”

Don’t be too hard on yourself

“Think of this as the long game,” de Ferranti emphasized. “There’s always another day to try and eat a healthier diet or get more sleep or go outside and get physically active.”

She said that “all in all, it’s about being pretty good overall — not perfect.”

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