The path to a healthy heart starts when we’re young, helping to ward off heart disease in adulthood. For tips on how to take care of our children’s hearts, we reached out to Andrew Souza, D.O., a pediatric cardiologist with the Heart Institute and director of the Cardiac Exercise Stress Lab at Children’s Hospital Los Angeles.
When we think of heart health, we typically think of older adults. Why should we be concerned about our children’s heart health as well?
Health problems do not develop suddenly. It is a collection of unhealthy choices made daily with cumulative effects over decades. Healthy lifestyles are a collection of good habits. These include eating healthy foods in an appropriate quantity and minimizing intake of sugar-sweetened beverages. Optimal habits also include participation in regular exercise. Trying to change routines and maintain new habits later in life is often quite challenging.
What are some common issues you see among kids and teens?
Cardiac symptoms related to complications of obesity are exceedingly rare during childhood, but children with obesity are at risk of developing high blood pressure, Type 2 diabetes, liver damage, asthma, sleep apnea, joint problems, other musculoskeletal complaints, anxiety, depression and low self-esteem. Thankfully, significant cholesterol problems in young children remain uncommon and are generally linked to other diseases. In those cases, we start medication to control LDL (bad cholesterol) levels to prevent heart disease in young adulthood and beyond.
How do food choices and physical activity affect heart health?
The earliest benefits of increased physical activity and/or improved diet can be demonstrated within the first few days to weeks. You can see reduction in blood glucose levels within a few days. Triglyceride levels (part of a standard lipid/cholesterol panel) can also begin to respond within the first week. LDL (bad cholesterol) and HDL (good cholesterol) will take a couple of months to improve. We commonly see the greatest initial impact in the child’s mood.
How has the pandemic affected eating habits and physical activity?
In the U.S., about 20 percent of children were obese prior to the pandemic, with the highest rates of obesity in Hispanic and non-Hispanic Black children. There was an increase of about three percent (at least two million new children) dealing with obesity after one year in the pandemic. Kids between 6 and 11 years of age were most affected, and those numbers only represent the start of the pandemic. There were multiple factors that impaired families’ ability to maintain a healthy lifestyle. These factors include local or self-imposed quarantines, with associated inactivity, job and/or home loss affecting food availability and quality and increase in junk food consumption. Many of my patients are still trying to find their way back to their pre-pandemic healthier routines.
Doctors often say, “eat healthy.” Please give us specific examples of what “healthy” means.
A healthy diet can mean different things to different people. I try to be cognizant of the child’s preferences, family culture and budgetary concerns. The focus should be on eating foods that contain vitamins, minerals and other healthy components.
Vegetables and whole fruits should take up half the plate of every meal. Vegetables should be varied as much as possible. Eat whole grains over refined grains (specific cereals, breads and brown rice vs. white rice and pastas). Cook your own meals and use olive oil over other oils when possible.
One of the most impactful things to limit is the consumption of sugar-sweetened beverages. For those who like to indulge in chips/crackers/cheese snacks from a large bag while relaxing or watching TV, I encourage families to divide the large bags into multiple snack-sized bags as soon as they get home from the grocery store. Using this technique, kids (and parents) do not unknowingly continue to eat more than they intended.
I would direct your readers to myplate.gov and dietaryguidelines.gov for more detailed information. They have excellent resources for understanding the current recommendations regarding optimal diet and portion size.
The last few years provided significant challenges to many children and families. If your child put on weight, the most important thing is to work together to help them. It is exceedingly difficult to improve a child’s lifestyle if the family is not all in together. If the parent does not buy those low-nutrient foods, the child (and parent) generally will not have the opportunity to eat them.
What is a good level of physical activity for kids and teens?
Kids need to find an activity they enjoy. We generally recommend 60 minutes every day with something as easy as walking. At least three days per week should include something more vigorous, such as running or something else that makes the heart beat fast. Ideally, kids would also do a few days per week of muscle-strengthening activities — like climbing on the playground or push-ups — and bone-strengthening activities, such as sports with impact: jumping, running or activities with a change of direction. Children who have been completely inactive will respond best to a slow ramp-up to transition to an active lifestyle. Start by walking for five minutes every day for a week and build from there. They can increase one minute at a time or add more five-minute sessions during the day.
What’s the best advice you can give parents to keep their kids’ hearts healthy from the start?
Be a good example. Do activities together. If you buy groceries together, kids can learn to be engaged in healthy decision making and creating a shopping list to construct a meal. Kids are more likely to try new things if they are involved in the buying and cooking process. Be active together. Go for a walk after dinner, play on the playground together. Be creative!
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