Did you know that heart disease—the leading cause of death in adults—can actually begin in childhood? While we often think of heart disease as an issue for grown-ups, the truth is that the foundations for lifelong heart health are built early in life.
Children may have two types of heart disease - congenital heart disease, which means they acquired it at birth and acquired heart disease which they develop as they grow. Acquired heart disease can be caused by an infection, medication, or another chronic disease. This second type is the one we are addressing today, because a portion of the acquired heart disease in children develop related to lifestyle and even if they do not develop heart disease in childhood they may be more at risk for developing heart disease in adulthood.
Many of the things we do in our daily lives can affect the development of heart disease. And as an adult, you may realize how hard it can be to change habits. So this is why I think it’s so important to establish heart-healthy habits early to reduce the risk of future cardiovascular issues.
Why Heart Health Matters
The heart is the powerhouse of the body, tirelessly pumping oxygen-rich blood to every organ and tissue, ensuring that a child can run, play, and grow strong. While heart disease is often seen as an adult issue, the foundations for lifelong heart health are actually laid in childhood. Factors like high cholesterol, high blood pressure, elevated blood sugar, and excess weight can strain the heart and blood vessels over time, increasing the risk of serious health problems later in life.
The rise of childhood obesity and its link to heart disease
About 1 in 5 children and adolescents are dealing with obesity, according to the Centers for Disease Control and Prevention. Childhood obesity has been linked to health issues such as high blood pressure, high cholesterol, and diabetes all of which contribute to heart disease. Additionally, extra weight may put extra strain on the heart.
Impact of high blood pressure, high cholesterol, and diabetes in childhood
High blood pressure, high cholesterol, and diabetes all damage the heart and blood vessels, and each condition increases the risk of developing the others.
- High blood pressure forces the heart to work harder to pump blood. Over time, the increased pressure strains artery walls, making them more prone to damage. These weakened areas become more susceptible to cholesterol buildup.
- High LDL (“bad”) cholesterol sticks to damaged artery walls, forming plaque that narrows the arteries. This not only reduces blood flow but also increases blood pressure as the heart must work harder to circulate blood.
- High blood sugar (as seen in diabetes) further weakens blood vessel walls, accelerating the damage caused by high blood pressure and cholesterol.
The role of genetics in congenital and inherited heart conditions
There are many congenital and inherited heart conditions that affect children. And while these are not a result of lifestyle, they are worth knowing about as these can also increase your child’s risk for heart failure, and sudden cardiac events.
Congenital heart defects (CHDs) are structural abnormalities present at birth, such as holes in the heart (septal defects), narrowed valves, or improperly formed heart chambers, which can impact blood flow and heart function. Some CHDs require surgery or lifelong management, while others may resolve on their own.
Inherited heart conditions, on the other hand, are genetic disorders that may not be present at birth but develop over time. These include arrhythmias (irregular heartbeats), cardiomyopathies (diseases affecting heart muscle function), and familial hypercholesterolemia (genetically high cholesterol levels). These conditions often require monitoring and intervention to prevent heart failure.
Long-term benefits of early intervention and prevention
Taking steps to monitor and protect heart health in childhood can have lifelong benefits, reducing the risk of serious cardiovascular diseases in adulthood. Early intervention—such as identifying high blood pressure, high cholesterol, or abnormal blood sugar levels, which we know can start in kids—allows for timely treatment and lifestyle changes that can prevent long-term damage to the heart and blood vessels. And also through screenings, doctors can also find the inherited heart conditions, which may develop in childhood.
When we know about heart conditions and risk factors early, we can establish heart-healthy habits early, like regular physical activity and proper nutrition, which will be more likely to continue into adulthood. Additionally any inherited heart conditions can be managed to improve long term outcomes. Being proactive with our kids' heart health, can set the foundation for a longer, healthier future.
Recommended Screenings
1. Blood Pressure Screening
The American Academy of Pediatrics recommends children have their blood pressure screened annually beginning at age 3. Blood pressure should be screened annually or more frequently based on risk factors.
2. Cholesterol Testing
Universal screening recommended between ages 9-11 and again at 17-21.
Earlier testing (starting at age 2) if there is a family history of high cholesterol, early heart disease or if your child has other symptoms, such as diabetes, high blood pressure or obesity.
Cholesterol screening is interesting, because there has been some controversy around it, and it is harder to do than a blood pressure test, because it requires taking blood. And while estimates vary, a study published in JAMA Network Open found that only 11% of people ages 9 to 21 are screened.
I think this test is important for 2 reasons. The first being that one of the acquired examples of heart disease, familial hypercholesterolemia can be detected and is far more common than many of the rare diseases for which newborn babies are routinely tested. And the second reason is that we are understanding more that imbalances of HDL and LDL cholesterol in childhood are closely linked to heart disease in mid-life. Finding out that your child has cholesterol issues gives you the chance to help them learn heart-healthy habits early.
What I am opposed to is using the screening to prescribe more medications in kids. We know lifestyle is playing a role in increasing risk factors for disease. Every effort should be to reverse the risk factors on kids.
3. Body Mass Index (BMI) Monitoring
Height, weight and BMI should be checked at annual visits.
I may be the first to chime in that BMI is not the most important indicator of health, BUT monitoring growth trends can be very informative in kids. If a child jumps up significant percentiles, there may be a need for intervention. Also, we have long known that increased weight is linked to heart disease. So from a heart health perspective, helping kids to be at a BMI less than the 85th percentile, with lifestyle change may be warranted, especially if there are any early signs of heart disease.
4. Blood Sugar (Glucose) Testing
The American Academy of Diabetes recommends screening for diabetes in all children 10 or older who are overweight or obese and with at least 1 risk factor:
- Family history of type 2 diabetes
- Maternal history of gestational diabetes
- Race or ethnicity that is American Indian, African American, Latino, Asian American, or Pacific Islander
- Signs of insulin resistance, such as acanthosis nigricans, hypertension, dyslipidemia, or polycystic ovarian syndrome
- Was born small for gestational age
5. Electrocardiogram (ECG/EKG) or Echocardiogram
Not routinely needed but may be recommended for children with a family history of heart conditions or symptoms like fainting or irregular heartbeats.
What Can Parents do to Support Heart Health
Parents are critical for helping kids build good habits to prevent heart disease. Here are the habits to focus on:
1. Provide and encourage a balanced diet
Good nutrition is one of the top things you can do to help prevent cardiovascular disease. Providing a balanced diet includes prioritizing fruits and vegetables, whole grains and lean meats, while avoiding or limiting saturated and trans fats, as well as sugary drinks and highly processed foods. Modeling eating plenty of fruits, vegetables, and whole grains can impact your child’s eating habits. Don’t give up offering nutrient dense foods. And here’s some easy things to start with:
- Have fruit routinely out at snack times
- Have cut up veggies out while prepping dinner
- Swap sweetened drinks for water
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Start swapping out refined grains for whole grains
2. Promote daily physical activity
Children should be physically active everyday. For children 3 to 5, it’s recommended that they are physically active throughout the day via play. This enhances growth and development. Children ages 6 to 17 should get at least 60 minutes of moderate to vigorous physical activity daily. This can be broken up but meeting these recommendations help to maintain good health and fitness.
3. Limit screen time and encourage active play
Since many kids trade being active for sitting in front of the TV or a computer, keep screen time to a minimum. Replace sedentary behavior with active behavior whenever possible.
The American Academy of Pediatrics recommends that children under two years old avoid screen time, except for video chatting with family. For children ages 2–5, the AAP recommends limiting screen time to one hour per day. For older kids, it’s recommended to create clear boundaries around screen time, and prioritize physical activity and adequate sleep.
4. Regular medical checkups to monitor heart health and discuss concerns
Lastly, you as the parent, can keep your child on track with regular medical check-ups and being informed by knowing what the screening recommendations are. If screenings are not done, or you have concerns about them, discuss with your child’s medical provider.
The choices we make today can set our children on the path to a lifetime of strong heart health. While genetics play a role, healthy habits and early screenings can significantly reduce the risk of heart disease. By encouraging nutritious eating, daily physical activity, and regular check-ups, we can help our children build a foundation for a longer, healthier future.
The good news? It’s never too late—or too early—to start. Small, consistent changes make a big difference, and the habits we instill now can empower our children to take charge of their health for years to come. Let’s give their hearts the best start possible!
References:
CDC facts on Obesity: https://www.cdc.gov/obesity/childhood-obesity-facts/childhood-obesity-facts.html
CDC Preventing Type 2 Diabetes in Kids: https://www.cdc.gov/diabetes/prevention-type-2/type-2-diabetes-in-kids.html
CDC facts on Cholesterol: https://www.cdc.gov/cholesterol/data-research/facts-stats/index.html
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Cholesterol Screening in Kids: https://www.heart.org/en/news/2024/10/25/do-kids-need-their-cholesterol-checked#:~:text=Those%20guidelines%20support%20the%20idea,disease%20or%20very%20high%20cholesterol.
Lipid Screening in Children and Adolescents - A guide from National Children’s Hospital