Preventing heart disease in kids: how can we doctors do better?

Claire McCarthy, MD

A week or so ago, the American Academy of Pediatrics came out with a report entitled “Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents.” It’s a 44-page report full of evidence-based recommendations for preventing kids from getting heart disease when they grow up.

I wasn’t going to write about it. After all, it seems like everyone’s eyes glaze over when I talk to them about diet and exercise; why should I waste the time writing something people likely won’t read? And even if they read it, chances are they won’t follow the recommendations. I know I sound cynical, but that comes from years of talking to families about healthy habits with really minimal results.

But here’s the thing: cardiovascular disease is the leading cause of death in the United States. And the risk factors and risky behaviors that lead to cardiovascular disease can and usually do start in childhood. I can’t really call myself a good doctor if I don’t talk about this stuff. I just wish I was more effective.

Look, I get it. I’ve done my share of cajoling/begging/yelling to get my kids to eat vegetables, with variable results. I know what it’s like to try to get a kid who has absolutely no interest in exercising to exercise (especially when it involves me exercising too—just kicking them outside, like our parents did, doesn’t always work out). We are all short on time and would prefer to keep negative interactions with our family to a minimum. Especially when it’s all about something that won’t happen for years (if at all).

Also tough: keeping our kids healthy means taking a long hard look at our own health and habits—because whether it’s the food we serve or the example we set, we have an impact.  It means eating better, not smoking, exercising, going to the doctor regularly, watching our weight and our blood pressure…ah! The eyes are really glazing over now. I can see it. Denial is way more comfy.

It’s not like we never make our kids do things for their future good. We push them to do well in school, we help them make choices that might help them get into a good college, even if they don’t like doing homework or aren’t interested in sports and clubs. (Maybe this is easier because we don’t have to change our habits.) But they aren’t going to get much out of being a doctor or lawyer if they die at 45 of a heart attack.

Like I said, the recommendations go on for 44 pages.  But here are the bottom lines, so to speak:

  • Family history matters when it comes to heart disease. Know your own cholesterol values.  Find out what Uncle Jimmy died of so young. If there is a change in your health or the health of a close relative, let your child’s doctor know.
  • Don’t smoke, or let your kids be around people who do—and do everything you can to stop them from smoking as teens. If you smoke, talk to your doctor about smoking cessation program.
  • Baby fat and kid fat turn into adult fat. Know your child’s Body Mass Index (BMI).  If it’s over the 85th percentile, take action. Don’t ignore it.
  • Make sure your child’s blood pressure is taken at every checkup from age 3 on, and talk to your doctor about when to do a blood test to check for hyperlipidemia (all children should be checked at age 9-11 and 18-21, but some might need it earlier or more frequently).
  • Eat healthy. This means:
    • Breastfeed for at least the first 6 months, if possible
    • Keep portion sizes reasonable
    • Serve whole grains, lean meats, and lots of fruits and vegetables
    • No sugar-sweetened beverages—and preferably no juice.  Low-fat unsweetened milk and water should be all anybody drinks.
    • Try to keep fat and cholesterol to a minimum (including fast food)
  • Shut off the TV and get your kids (and everyone) moving for an hour a day.

I know, you’ve heard all of this before. We all have. But here’s why: because it’s important.  It could literally save your child’s life.

It makes me sad every day that I can’t seem to make significant changes with my patients when it comes to diet and exercise and weight and smoking and everything else. I try to work with families and understand their individual lives and needs, but it’s not enough. My friend and fellow doctor-blogger Wendy Sue Swanson is asking her readers for their perspectives and practical suggestions—maybe that’s what all of us doctors should be doing.

So if your eyes haven’t totally glazed over, chime in. Why aren’t we doctors more effective? What should we be doing differently? What makes it hard? What has worked, or might work, for you?