Building heart healthy habits at a young age can put a child on track to have a healthy heart for life. This is especially true for children and teens who have early indicators of heart disease.
"We're seeing an increase in high cholesterol, high blood pressure and obesity among children as early as preschool age," says Clarisa Garcia, M.D., Medical Director at Pediatric Cardiology Associates of Houston and Pediatric Cardiologist at Children's Health℠. "The good news is that when we catch these indicators early, we can take steps to avoid more serious heart problems down the line."
Dr. Garcia discusses heart disease risk factors in children, when children should get screened for heart problems and offers advice on how families can reduce their child's risk of heart disease.
What are the different kinds of heart disease in children?
Heart diseases in children fall into one of two categories: congenital and acquired.
Congenital heart disease
Some children have congenital heart disease, as called congenital heart defects, which means a heart problem a child is born with. Congenital heart diseases happen when a child's heart does not form properly in the womb. Around 1 out of every 100 children is born with a congenital heart defect.
Some congenital heart defects are mild and get better on their own over time, while others are more serious and may require surgery. Congenital heart diseases in general cannot be prevented, but making sure the mother is as healthy as possible with routine prenatal care and avoiding exposure to alcohol and smoking (including secondhand smoke) can help to reduce the risk.
Acquired heart disease
Acquired heart diseases are heart problems that a child develops over time – either in childhood or adulthood. Acquired heart diseases that affect children are not common and include:
- Rheumatic heart disease, which can develop when a child has rheumatic fever. Rheumatic fever can happen if a child does not get prompt treatment for strep throat or scarlet fever.
- Kawasaki disease, a condition that causes blood vessels to swell and may lead to heart damage
More commonly, children may develop early warning signs of acquired heart diseases that develop during adulthood such as coronary artery disease (CAD).
CAD affects the blood vessels that supply oxygen and nutrients to the heart. This can happen when fat, cholesterol and other substances build up in the arteries, making it more difficult for the heart to pump blood. When you don't treat it, CAD can lead to serious problems like heart attack and heart failure.
"There are many factors that cause CAD but the most common ones are high cholesterol, high blood pressure, smoking and diabetes," Dr. Garcia says. "If warning signs like high blood pressure and high cholesterol show up in childhood, it not only means that they may be on track to develop CAD, but that they may develop CAD earlier in adulthood."
What are heart disease risk factors in children?
Certain symptoms, behaviors and conditions during childhood can increase the likelihood of a child developing heart disease later in life. These risk factors include:
High cholesterol
A child can develop high cholesterol as a result of a high fat diet, not exercising enough or being overweight. Children can also develop high cholesterol as a result of a genetic problem where their body cannot get rid of cholesterol from the body properly.
"High cholesterol can happen at any age. If it's genetic, we can often see it in preschool aged children. Children with certain risk factors should be screened younger but universal screening is recommended between ages 9 to 11 years," Dr. Garcia says.
High cholesterol can cause inflammation or plaque buildup in the arteries, which can lead to problems like CAD and heart attack later in life.
Managing high cholesterol typically starts with reducing how much saturated fat your child eats and increasing their exercise. Dietitians at Children's Health can help families find meals they enjoy with fewer saturated fats. If these changes are not enough to get a child's cholesterol into a healthy range, doctors may recommend cholesterol-lowering medication. Learn more about high cholesterol in children.
High blood pressure
Blood pressure is a measurement of how hard blood pushes against the walls of the arteries as the heart pumps blood. When blood pressure is consistently high, the heart has to work harder to pump blood which can eventually increase the risk of heart failure and heart attack.
"High blood pressure doesn't usually cause symptoms unless it's extremely high, so people may have high blood pressure and not know it," Dr. Garcia says. "That's why we always check it at regular well-child visits."
High blood pressure can also develop as a result of a kidney or hormone issue, so doctors will do an evaluation to look for the cause of high blood pressure. If the doctor doesn't find another health issue, the first two steps to help reduce blood pressure in children are to reduce how much salt they eat and increase their exercise to at least 30 minutes most days.
"This doesn't have to be structured exercise, they just need to get moving — like playing on the playground, doing a sport or taking a walk with the family," Dr. Garcia says. "We typically start managing high blood pressure by encouraging children to move more and to lower salt and then use medications if necessary."
Learn more about high blood pressure in kids.
Diabetes
According to the Centers for Disease Control and Prevention (CDC), people with diabetes are around twice as likely to develop heart disease or stroke as someone without diabetes – and at a younger age. People with both type 1 and type 2 diabetes have a higher risk of heart disease. Heart disease can happen in people with diabetes when high blood sugar damages blood vessels and nerves that play an important role in heart health. Having diabetes also makes a person more likely to have high blood pressure and high cholesterol, which contribute to heart disease.
Following a healthy diet, getting regular exercise and maintaining balanced blood sugar levels can help reduce the risk of heart disease. Talk to your child's doctor about specific steps they can take to manage diabetes and mitigate the risk of heart disease.
Obesity
Obesity can increase a childs risk of developing heart disease later in life. Many children experiencing obesity have at least one factor that increases their risk for heart disease, such as high blood pressure or high cholesterol, and many have two or more. Overweight children under age 13 may start to develop heart disease as early as 25. Maintaining a healthy weight and regular exercise can help lower the risk of heart disease related to obesity.
Smoking
Smoking is a leading cause of heart disease according to the CDC. Smoking can cause cells within blood vessels to swell, which can lead to many heart conditions.
"We do see adolescent patients who are smoking, which we strongly advise against," Dr. Garcia says. "Further, we recommend avoiding any exposure to cigarette smoke, so that means avoiding being around people who are smoking to limit exposure to secondhand smoke."
Should a child or teen have certain screenings if they have a family history of heart disease?
Children over age 3 will generally get their blood pressure checked at every visit to the pediatrician. Pediatricians typically check a child's cholesterol once between ages 9 and 11 and again between ages 17 and 21.
"We recommend asking your doctor based on the specific history of heart disease in your family," Dr. Garcia says. "In general, if you have a family history of high cholesterol, high blood pressure, diabetes or CAD diagnosed before age 55, we may recommend earlier or more frequent blood pressure and cholesterol checks."
Learn more about the most common heart disease screenings for children.
How can you prevent or reduce heart disease risk factors in kids?
Eating lots of heart healthy foods and regularly exercising can reduce your child's risk of heart disease. This includes:
- Cutting back on saturated fats by eating less sausage, bacon or burgers
- Decreasing sugars in a child's diet and avoiding sugary drinks
- Lowering the amount of salt your child eats by buying low-sodium soups or beans and cutting back the amount of salt in recipes
- Increasing Omega-3 fatty acids (often found in fish) and fiber (like fruits, vegetables, grains and beans) in your child's diet
- Making sure your child gets 30-45 minutes of movement several days per week such as outdoor play, sports, walking or biking to school, swimming or dancing
Signs of a potential heart problem in kids and when to seek care
In general, contact your child's doctor if your child has chest pain, is much more tired than usual or notices that they have less stamina, shortness of breath or abnormal heart beats when exercising.
"The heart is supposed to beat faster when a person exercises. If your child's heart or chest feels different or they're really short of breath with activity, they should be checked out," Dr. Garcia says. "While these symptoms may not be due to any heart disease, we definitely want to see a kid if they're having new symptoms with exercise."
Learn more
Children's Health is dedicated to giving families the care and resources they need to manage early warning signs of heart disease and build habits that lead to healthy hearts. Learn more about the Cardiology Program at Children's Health and find more resources in our Health and Wellness Library.
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