Children should have blood pressure and cholesterol checked by age of 5

Because cardiovascular disease is the leading cause of death in the United States, doctors should start promoting cardiovascular health among their patients from birth, an American Heart Association committee said last week.

The committee recommends that doctors aim to increase children's physical activity, prevent or treat obesity, counsel children and their parents, assess insulin resistance as a risk for type II diabetes, check for high blood pressure and high cholesterol concentrations, and prevent cigarette smoking. The guidelines are published in Circulation (2002;106:143-60).

Also last week, Pediatrics, the journal of the American Academy of Pediatrics, published a supplement on ways to combat obesity among children (2002;110(suppl):203-38).

The American Heart Association committee was headed by Dr Christine Williams, director of the Children's Cardiovascular Health Center at Columbia University's Babies and Children's Hospital in New York.

“Heart disease begins in childhood. Fatty streaks appear in the aorta in three year olds and some have disease in the coronary arteries by age 10. The guidelines focus on keeping kids' hearts healthy,” she said.

At a prenatal visit or the first visit after a baby is born the doctor should take a family history of cardiovascular disease and ask about smoking habits, the guidelines advise.

When the child begins to eat solid food, the doctor should advise on a nutritious diet that is low in salt, saturated fat, and cholesterol. Blood pressure should be measured from about the age of 3 years and cholesterol at about 5 years.

Doctors should encourage parents to set an example through a healthy diet and physical activity. Between the ages of 6 and 10 years children should have a cardiovascular risk profile taken. Doctors should reinforce the “heart-healthy” pattern during the preteen years and adolescence, with an emphasis on avoiding smoking.

Childhood obesity was addressed in six papers in the Pediatrics supplement. “We wanted to get a better understanding of the attitudes and practices of healthcare practitioners in dealing with overweight children, given the current epidemic. These people are on the front line and they're critically important,” said Mary Story, professor of public health nutrition at the School of Public Health at the University of Minnesota, Minneapolis, and lead author of one of the studies.

The aim of the studies in the supplement was to determine whether the recommendations of an expert panel six years ago were being followed. A questionnaire was answered by 202 paediatricians, 293 paediatric nurse practitioners, and 444 registered dietitians. The response rate among these groups varied from 19% to 33%.

Most of the respondents were worried about obesity in children, knew its medical impact, and believed that it needed treatment. However, they felt least skilled in behavioural counselling, compared with other treatments,and wanted more training. The respondents said that barriers to treatment included lack of motivation among children and lack of parental involvement, lack of support services, and lack of reimbursement by insurance companies. Many practitioners were reluctant to treat obese children unless they had a medical condition, although obesity alone may predispose to type 2 diabetes.

The American Heart Association's guidelines can also be accessed athttp://www.circulationaha.org/