Heart Smart from the Start!

Cardiovascular health for kids, Audey Lewis Veach, MD

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Most children start out life with healthy hearts and it’s important to establish healthy habits early to keep them that way.  Pediatric cardiovascular health can be broken down into three major categories:

  • Know your risk factors
  • Get (and keep!) moving
  • Eat (and drink!) smart


Risk factors for early heart disease- Just like your crazy aunt who sends you weird sweaters for Christmas every year, there are some cardiovascular risk factors that are in your control and some that you’re just stuck with.  The traditional risk factors for early cardiovascular disease are high cholesterol, obesity, diabetes (type 1 or 2), high blood pressure, family history of premature cardiovascular disease and cigarette smoke exposure.  Some other medical conditions like kidney disease, Kawasaki disease, childhood cancer and certain congenital heart defects also increase risk.  The more risk factors a child has, the higher the risk for developing early cardiovascular disease and the more important it is to minimize the risk factors that you do have control over.  Your child should see their primary care physician for a well-child check every year to discuss family history, nutrition and activity levels, growth curves including BMI and check blood pressure.  It is recommended for all children to have their cholesterol checked at 9-11 years of age and sometimes earlier if there are significant risk factors.


Get (and keep!) moving- Infants and toddlers are naturally active.  As children get older, their activity levels can decline, especially if a lot of screen time enters the picture.  Some kids are involved in vigorous exercise through organized sports but that isn’t a good fit for all children.  Often times, parents assume their children are getting enough exercise when they really aren’t and this is important even if your child has a healthy BMI.  If exercise isn’t scheduled into your child’s days/weeks through organized sports, it’s important to find activities to get them active and find places to fit it in.  Some general recommendations that can help include-

  • Limit screen time (discourage altogether under 12 months, minimal under age 2, no more than 1-2 hours/day all other ages).
  • No TV in children’s bedrooms.
  • Encourage moderate to vigorous activity daily and 1 hr of vigorous activity 3 days per week
  • Some activities that may be a good fit for children not interested in team sports are tennis, swimming, rock climbing, roller skating or roller blading, jumping on a trampoline, jump rope or pogo stick, bike riding.
  • Engage in whole family physical activity at least once a week.  My favorites are hiking, biking, and roller skating.


Eat (and drink!) smart

  • Start early- offer a wide variety of foods from first introduction.  Focus on fruits, vegetables, proteins and healthy fats.
  • Don’t fall into the toddler food trap- many toddlers will eat mac n cheese, chicken nuggets and French fries all day long if they’re allowed to.  If this becomes a struggle, eliminate these options entirely to encourage a healthy, well rounded diet.  From an early age, children should eat the same meals as their parents and not have separate “kid meals” made for them.
  • HALF THE PLATE!!  At lunch and dinner, ½ the plate should be fruits and vegetables.  Sometimes using divided plates, even for older children can be helpful to make this happen.
  • 5 servings- the goal for fruits and vegetables is 5 servings per day which most children are not getting.  I try to always give a fruit and a vegetable at lunch and dinner for 4 servings as well as a fruit at breakfast or snack to hit the goal of 5.
  • Be sneaky- I love finding sneaky ways to hide vegetables in meals.  Grated zucchini hides well in red sauce and lots of baking recipes that aren’t necessarily complicated.  Frozen cauliflower rice hides well in chili, fried rice and taco meat.  You can put tons of spinach in a fruit smoothie for a beautiful green color without any spinach taste, call it a slime smoothie and it may be even more attractive.
  • Be creative- this doesn’t mean you have to spend tons of time.  In toddlers, using a muffin tin or ice cube tray to put small amounts of lots of different food items can be very exciting and effective.  For slightly older kids, making food faces on a blank plate, for example with a cantaloupe smile, strawberry nose, cucumber circle eyes and shredded cheese hair, can pack a real fruit and vegetable punch.   Minecraft meals were a big hit at my house for a while, I just cut everything into cubes and I swear, they couldn’t get enough!  Try preparing the same item different ways, my kids thought whole or quartered Brussel sprouts were like poison then we tried shaved Brussel sprouts and success! 
  • For picky eaters, encourage one “polite bite” of each food on the plate.  Research shows it can take multiple attempts at a new food for children to develop a taste for it.
  • Minimize fast food- goal no more than 1x/week, if it has to happen more often, be conscious of healthier choices like apple sauce instead of French fries or grilled nuggets instead of fried.
  • Encourage WATER- there is no healthier beverage, get kids accustomed to it early by keeping juice for special occasions and not daily use and limiting juice, sports drinks and soda as kids get older.
  • Set an example- parents, all of these pointers apply to you, too!  Your kids need to see you eating a healthy diet to set an example for them (but also for your own heart health!).
  • Family dinners- life is BUSY but sitting down at the dinner table with screens off as a family whenever you can is important on many different levels.
  • Lastly, for nutrition and exercise, JUST KEEP TRYING!  Remember it’s a marathon and not a sprint, establishing healthy habits or changing already established habits takes time, patience and persistence.  You’ve got this!


  • Preservice Teachers Learn to Use Be Active Kids in Limited Spaces

    I really enjoyed our class meeting. It was interesting to discover that you can do just about anything with children in the classroom where there may not be much space to encourage them to be active.  A change that I will make in my own life is to be more active, as well as my daughter. I will share this information with my friends that have children such as yoga animals, or Simon Says.

    Cathy Sesta, Parent & Child Care Provider
  • Early Childhood Physical Activity Institute

    Thank you for inviting me to be part of this year’s Institute. I can’t tell you how much I enjoyed the experience. You’re doing amazing work and I hope I’ll be able to continue contributing to it a bunch in the future.

    Rae Pica, www.movingandlearning.com
  • Plenty of Resources That I Can Use and Share

    This class was informative, and I look forward to being physically active with young children. On Friday, I volunteered at a Parents Night Out through my daughter's school. When I got there the kids were watching a movie. I got them up to play Simon Says and Red Light Green Light, however, after that I was stuck on what to do. I wish I had the knowledge I gained from this class, to have made it more exciting.

    I enjoyed your Land and Lake Activity.

    Venessa Wright, Parent & Child Care Provider
  • Be Active Kids Trainers Rock!

    I loved the training.  I would have loved it more if I had the other teachers from my center there also.  I am really looking forward to taking my kit to work and sharing it with my staff.  I liked Brittney, she reminded me of myself as far as being very active and motivated.  When I am at work with my little ones we stay busy all day.  I feel like singing my instructions and dancing my actions helps them to focus better on what I need for them to do.  Britney was great and I learned a lot from her. I am always trying to find new little ways to get the kids moving.

    Tiffany Daniel, Sandhill Community College

    The Early Childhood Physical Activity Institute was just wonderful!  Thank you again for including me in such an important effort to create and sustain leaders in EC physical activity. I would love to return to NC anytime that you think I can help. I enjoyed meeting the folks who work with you and hearing about all of the great things that are planned. 

    Linda Carson, Choosy Kids
  • Be Active Kids has Much to Offer

    Congratulations to you and everyone who has been promoting PA for young
    children in NC. You have much to be proud of here. Be Active Kids is an excellent source of ideas for promoting active play in unstructured settings. The Be Active Kids website also has resources on promoting unstructured active play. I encourage folks to review these resources. 

    Diane Craft, SUNY Cortland & Active Play Books