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Ginnie Abarbanell, MD (Guest): Hi, my name is Ginnie Abarbanell. I am a pediatric cardiologist at Washington University and also a MomDoc at St. Louis Children’s Hospital.

Melanie Cole (Host): Welcome. This is MomDocs, the podcast from St. Louis Children’s Hospital. I’m Melanie Cole and today, we’re talking about cardiovascular health and your children. Dr. Abarbanell, I’m so glad to have you with us to discuss this topic today. It’s not something that kids tend to think about or really even their parents is the cardiovascular health. But with the obesity epidemic with childhood, that we are seeing today; more children are now at risk for cardiovascular disease. Tell us a little bit about the prevalence of heart problems in children and what you are seeing.

Dr. Abarbanell: So, with the increasing in overweight adults we are also seeing an increase in overweight children. It is estimated that about 20-25% of children are overweight. As you can probably imagine, because of that, that also predicts later overweight and obesity in our older adult patients as well which leads them up to having risks for early coronary artery disease as well as other things that can be related to the other parts of your body.

And so, we are seeing that in kids, and it is a bout 20-25% prevalence. We are also seeing with that, an increase in high blood pressure as well as some increase in insulin resistance in particular.

Host: Just not something that we used to see that much or that we would think about. So, tell us a little bit about exercise and a child’s heart because we think of children’s hearts as these perfect little machines and exercise comes naturally. So, do they have the same benefits as they would for someone my age?

Dr. Abarbanell: Of course they do. Exercise is good for anybody at any age and you are correct. So, they do have perfect little hearts in most scenarios that can exercise with no difficulty. And we are finding that with the increase in screen-time, that this has been correlated with increases in overweight children and a decrease in exercise. So, it is always healthy to get your kid out exercising and doing something, at least for 30 minutes a day, every day.

Host: Well then let’s talk about how we get them to do that. We want to encourage good heart health, but some schools Dr. Abarbanell, are cutting gym and recess in favor of studying and STEM projects and things and so maybe kids aren’t getting as much exercise at school, then they come home, and they have homework and they are stressed out. What do we do? How do we encourage good heart health for our children?

Dr. Abarbanell: The best way to encourage good heart health for your children is to demonstrate it yourself as the parent and to make it a family affair. And really make it a priority. Because as anything in life; when we become adults, we have to make it a priority for us to exercise or make that part of our routine and the same thing needs to happen with kids.

But with kids, the best bet is try to get them involved in something they enjoy doing so it doesn’t become something that they don’t want to do. So, try to pick some activity where they are active but yet having fun in the process.

Host: Does it change as they grow into an adolescent? How does heart health evolve as a child grows? As they are little guys, maybe they are playing soccer and they are running around on the playground, but then as a teenager; if they are not involved in sports, then it has to be some kind of formalized exercise. Is there a difference between little guys and teenagers?

Dr. Abarbanell: As far as the need for exercise, I would say there isn’t a change, but we do know that in regards to heart health and specifically for coronary artery disease which leads to early heart attacks and the like, that we can see these plaques that develop as early as into childhood. And so we do know that by taking care of ourselves and especially as a young adult; these are good practices to get into so that they can continue into adulthood.

Host: So, cardiovascular exercise obviously, is so important. But we’ve learned so much about how important our diet is for cardiovascular health and teens, wow, they can just be junk food machines. What do you want use to know about kids and eating and their metabolism as it starts to slow down a little and eating that junk food which could contribute to cardiovascular disease later on?

Dr. Abarbanell: Well I think we always have to think about what we feed our kids and how that is going to affect them when they – they are eating as adults. And so, if you’ve been eating junk food all through childhood or into adolescence; then it’s hard to develop a pattern of actually healthy eating when you become an adult and live on your own.

And so, these kinds of things if we can get this to happen within the family or at home as a child or adolescent then making healthy food choices doesn’t seem to be such a difficulty as we become adults.

Host: Kids tend to think that they can get away with it a little bit more. That’s what I sort of see Dr. Abarbanell, so what do we want to try and encourage our kids to be eating? Salads and greens, and vegetables and fruits and those sorts of things; they are kind of a pain to make, so sometimes then is it up to the parents to make sure that their kids are eating healthy?

Dr. Abarbanell: It definitely is up to the parents especially when the kids are younger and I have taken a stance, I think it is always good to try to eat your fruits and vegetables first before you eat the other stuff. So, try to eat the healthy food before you eat the unhealthy food and what you’ll find is that when you do that then you are not as hungry, and you may actually eat less of the unhealthy food. If fruits and vegetables are available, most kids will eat them; but if they have to do something to make the fruits and vegetables available; then they are less likely to grab that to eat.

Host: That’s exactly right and one thing I found that worked with my kids when they were little is, I had a garden, so they helped me plant the seeds. They didn’t love weeding. But then they helped me to harvest beets and carrots and peppers and tomatoes and so then they wanted to help to do something with them and they enjoyed eating them. So, as a result, I’m lucky because my kids eat very healthy. But getting the kids involved in the kitchen is a great way, isn’t it?

Dr. Abarbanell: It certainly is because then they get involved and then they want to try new things. I think that’s the hardest part with kids is that they are sometimes resistant to trying new foods and if you get them into the kitchen making healthy foods together; they are definitely more liable to try to try the new foods and might find out that they actually like them.

Host: So, children get chest pains, as we all do for various reasons whether it’s stress and anxiety or reflux or gas or whatever; when should a child see a cardiologist? Should they see a cardiologist at some point? Is there something that would signal a parent saying you know what, maybe I need to book a specialist?

Dr. Abarbanell: So, chest pain can be common in kids and you are correct. Most of the time it is not related to the heart. It’s actually related to the heart less than one percent of time in kids which is as a good thing is reassuring. But the things that I look for that are red flags with chest pain is if you get chest pain with exercise. If a child has chest pain and then passes out. If a child complains of chest pain and their heart racing. Those would be my top three flags of when to have that child be seen by a cardiologist.

Host: And tell us a little bit about some of the services that are offered at the Heart Center at St. Louis Children’s Hospital for children with heart conditions.

Dr. Abarbanell: So, at St. Louis Children’s, we do the full range of services for our kids. We follow several children who have congenital heart defects and who have undergone surgical repair as needed and we follow them lifelong. So, offer fetal echocardiograms which is basically looking at the fetal heart to diagnose significant congenital heart disease before the baby is born which helps us in planning for that baby to be born. Additionally, we see healthy children with heart murmurs, chest pain, patients who are fainting or have syncope and then we can transition them over to our adult congenital heart program where our patients that have congenital heart disease can be seen by a specialized doctor who takes care of adults that have congenital heart disease.

Host: Such great information and wrap it up for us Dr. Abarbanell, with how often you want our children to exercise, what kinds of exercise you most recommend that would be really, really good for their hearts and your best advice about cardiovascular health in our children.

Dr. Abarbanell: So, my best advice would be one: eat your fruits and vegetables, eat them before you eat some of the other stuff on your plate. Number two: would be to try to get daily exercise for at least thirty minutes a day which in younger kids can be a simple as going to the park and playing and as we go into the summer months, could be going to the pool and playing in the pool. And then as our teenagers get older and helping them to establish daily routines or at least three to four times routines of that they are actually doing physical activity for thirty minutes a day and that could even include going for a walk for thirty minutes.

But when you are going for a walk, you do need to make sure that it’s a brisk walk so that you actually can get a little bit a raise in your heartrate.

Host: Thank you so much Doctor, for joining us today and giving parents such clear and concise information about teaching our children good heart health that can last them their whole lives. Thank you again. And that wraps up another episode of MomDocs with St. Louis children’s Hospital. Head on over to our website at www.stlouischildrens.org for more information and to get connected with one of our providers. If you found this podcast informative, please share on your social media and be sure to check out all the other interesting podcasts in our library. And until next time, this is Melanie Cole.