Most people know that high blood pressure and cholesterol are risk factors for heart disease. But what they often don’t think about is starting prevention in childhood.

New recommendations from the National Heart, Lung, and Blood Institute advise that all children get their first cholesterol check between 9 and 11 years of age, rather than waiting until they reach 18 or 21. Children who have a first-degree relative who has had a heart attack before age 55 can be screened as young as 2 years old.

“The goal is to identify risk factors for heart disease early on so we can reduce their risk in adulthood,” said Dr. Marsha Novick, a specialist in obesity medicine at Penn State Hershey Children’s Hospital. “Heart disease is the No. 1 killer of both men and women, so the earlier we can attack the problem, the better we can prevent serious illness.”

Dr. Thomas Chin, chief of pediatric cardiology at Penn State Hershey Children’s Heart Group, said when people think of children and heart problems, they often focus on structural defects the children may have been born with rather than preventing problems from developing in an otherwise healthy heart.

“To put it in perspective, 1 percent of children are born with congenital heart defects, but 18 percent of children are overweight and the number of adolescents who are obese has quadrupled to 21 percent,” he said, citing recent numbers from the Centers for Disease Control and Prevention.

“The emphasis in children’s heart health has shifted from a focus on congenital defects alone to include preventative cardiology,” Chin said. As part of a child’s regular check-up, pediatricians typically measure height, weight and blood pressure. Now, they are adding screenings for high cholesterol and diabetes in younger children.

While there is no magic pill to prevent heart disease, Novick said parents must lead the way and model healthy behaviors and habits. Parents are the ones doing the grocery shopping and providing food to their children. They are the ones who lead decisions about whether leisure time is spent in front of a screen or doing physical activity.

“Parents can be extremely influential and promote healthy heart habits that last a lifetime,” she said.

Chin agreed: “It is one thing for us to look at a child, but it is the entire family that needs to be educated and participate for the effort to be successful.”

Novick offers the following six steps to a healthy heart for both children and adults:

1. Eat right. Select fresh fruits and loads of vegetables, and include foods like whole grains, dairy products, fish, skinless chicken and lean meats. Read labels to find foods with less trans and saturated fat.
2. Get active. The American Academy of Pediatrics recommends children get an hour of moderately intense physical activity every day. Brisk walking, swimming and even Wii Fit video games, dancing games or exercise videos on YouTube are fun ways to get kids moving. Local pools and activity centers such as the YMCA are good resources for days when it is too cold to play outdoors.
3. Manage your weight. Those who are overweight or obese should work on weight loss to reduce their risk of heart disease.
4. Avoid tobacco. “We would always hope your child is not smoking, but remember that even exposure to secondhand smoke increases the risk of heart disease,” Novick said.
5. Get screened. Have your family doctor or pediatrician monitor your child's weight, blood pressure and cholesterol.
6. Control stress. Meditation, yoga and deep breathing exercises can be done by the whole family because they can improve heart health. Regular physical activity also helps with stress reduction.

The Medical Minute is a weekly health news feature produced by Penn State Milton S. Hershey Medical Center. Articles feature the expertise of Penn State Hershey faculty physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.