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The consequences of heart disease often don't show up until someone is well into adulthood. Why should busy parents be thinking about it in their kids?

"Because it's probably way easier to prevent the development of cardiac risk factors than to try and get rid of them once they've developed," said Dr. Sarah de Ferranti, a pediatric cardiologist at Boston Children's Hospital. "Prevention really is key."

Most people don't think about risk factors during childhood, said de Ferranti, who also is an associate professor of pediatrics at Harvard Medical School. "But I think it's actually essential that we all start doing that."

According to a in the ľ¹ÏÖ±²¥ journal Circulation, only 2.2% of 2- to 19-year-olds had "optimal" scores on a scoring system that included diet, physical activity and body mass index. And while nearly 57% of 2- to 5-year-olds had high scores, among 11- to 19-year-olds, that fell to 14%.

Protecting a child's heart health can begin with a focus on a mother's health during or even before pregnancy, said Dr. Amanda Marma Perak, senior author of the Circulation study and a pediatric cardiologist at Ann and Robert H. Lurie Children's Hospital of Chicago. But if you have a child and you haven't been thinking about their heart health, "now is the time to start," she said.

Perak and de Ferranti offered this advice.

It starts with eating

Healthy eating habits are crucial for heart health. They also can be challenging to figure out.

"I think first is just understanding, what is healthy food?" said Perak, who is also an assistant professor of pediatrics and preventive medicine at Northwestern University. She recently helped write an to the AHA's scoring system for heart health now known as Life's Essential 8. It weighs eight contributors to heart health for children and adults: diet, physical activity, nicotine exposure, sleep health, body weight, blood lipids (cholesterol and other fats), blood glucose and blood pressure.

To help families understand what makes up a healthy diet, Perak uses the Department of Agriculture's . It envisions a diet where half the food is vegetables and fruits, a quarter is lean protein and a quarter is whole grain, with a side of dairy.

Be patient

For picky eaters, a light touch can pay off, de Ferranti said. She's found it effective to serve fruits and vegetables first, when children are hungriest, "as opposed to engaging in major battle" around eating a specific amount.

It's a long game that might require exposing kids to healthy foods many times, de Ferranti said. "Try, try, try. Try again. Be persistent."

Keep 'em moving

Exercise can start young, Perak said. "Even for a baby, you can think about getting them active in terms of tummy time and not restricting them in carriers and highchairs for a long time."

Whether it's through a formal class or just playing at a park, physical activity should be worked into a family's schedule, de Ferranti said. But the activity should be age-appropriate and align with the child's interests.

Perak has patients who enjoy dancing or just doing simple exercises at home. Organized sports can be "super helpful," Perak said. But if pushed too hard, they can also add stress and cut into sleep time.

Sleep on it

A sleepy child might be less likely to be physically active or might crave unhealthy food in search of an energy burst. Poor sleep, for example, is associated with obesity in kids.

According to the AHA, the daily amount of sleep a child needs to promote healing, improve brain function and reduce the risk for chronic disease varies by age: 12 to 16 hours (including naps) for ages 4 to 12 months; 11 to 14 hours for ages 1 to 2; 10 to 13 hours for ages 3 to 5; 9 to 12 hours for ages 6 to 12; and 8 to 10 hours for ages 13 to 18.

Come up with a bedtime routine that allows time for calming activities. "There's definitely research showing that having consistency around bedtime routines is associated with getting an adequate amount of sleep in kids," Perak said.

Kids can have high blood pressure, too

Knowing your child's blood pressure numbers is important, but measuring it in kids is tricky, de Ferranti said. The numbers for what's considered high blood pressure vary by age, height and gender.

"Your pediatrician should be your go-to for that," she said.

Understand mental health's importance

Mental health is important to heart health, de Ferranti said. Stressful events in childhood to unhealthy behaviors and cardiovascular problems later in life.

Over the past two years of the pandemic, de Ferranti has seen the effects of stress in real time. "I've seen a lot of young people show up in my pediatric cardiology practice with high blood pressure or other symptomatic complaints like chest pain, heart palpitations or dizziness."

Parents should watch their children for these and other signs of distress and ask for help if needed, according to a about youth mental health that offers advice for young people, parents, professionals and educators.

Be ready for change

As with anything related to parenting, de Ferranti said, parents need to stay alert.

A decade ago, for example, the health threat from vaping was unknown. Now, indicates e-cigarette use can harm cardiovascular health.

"We have to be nimble," she said, "because the world keeps changing."

Don't be too hard on yourself

"Think about this as the long game," de Ferranti emphasized. "There's always another day to try and have a healthier diet or get more sleep or get out there and get physically active."

She said that "all in all, it's about being generally pretty good – not perfect."

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