Melanie Cole, MS (Host): There's no handbook for your child's health, but we do have a podcast, featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And joining me today is Dr. Amanda Lin. She's an instructor in Medicine and Pediatrics at Weill Cornell Medicine, and she's here to highlight heart health in children for us today.

Dr. Lin, thank you so much for joining us today. Before we begin, just tell us a little bit about yourself and how you came to Weill Cornell Medicine.

Dr. Amanda Lin: Yeah, sounds good. Thanks so much for having me on. Yes, my name is Dr. Amanda Lin. I started a few months ago as a family medicine physician here at Weill Cornell Medicine. I am seeing all generations of the family from newborns to grandma and everyone in between. Excited to be here.

Melanie Cole, MS: Well, thank you so much for sharing that. Now, let's talk about heart health in children. How early should parents start with their kids to promote heart health from a young age? I'm an exercise physiologist myself, so I know that I started with my kids really early. But tell us a little bit about what you want parents to know.

Dr. Amanda Lin: Yeah. That's a fantastic question. So, this actually starts as early as birth. So, studies have shown that breastfeeding, especially for the first six months of life, and ideally up to the first 12 months of life, does have a link with decreased future obesity, and even decreased high cholesterol in the future. And of course, as a child gets older as they become more of the infant, toddler age, starting to eat solid foods, you really want to start emphasizing those nutritious foods early. And also, even things like the power of play. Play is essential to a child's health and development, socially, cognitively, in just a few ways.

And then, some other general goals to start from an early age is eating a balanced diet with daily physical activity, limiting screen time to no more than two hours per day, limiting sugary drinks, having a healthy quality sleep, and avoiding tobacco exposure. That way, we can help to decrease risk factors are associated with heart disease later in life. And as a family medicine physician, I do see, everyone across all generations, they do see the importance of starting early to prevent chronic health disease issues later in life.

Melanie Cole, MS: And we're going to talk a little bit about that as well. But what about nutritional guidelines? You just talked about breastfeeding and sugary drinks, but there are some things that parents don't really realize that they may be giving their children that can contribute to poor heart health and or obesity. Just like fruit juice, for example, we think of that as something healthy. But really, it's got a lot of sugar in it. We'd rather eat the fruit.

Dr. Amanda Lin: Yeah, exactly. And studies have shown that the food that we feed our children in infancy and as children does have lasting effects into adulthood. So, some general guidelines are to give a variety of nutrient dense foods from basic food groups. For example, your cow's milk, fortified soy products, healthy quality meat and protein, grains, fruits, and vegetables. And of course, try to avoid adding things like sugar, salt, or caloric sweeteners as much as possible.

Some other general guidelines are in terms of meat and proteins. Try to select the options that have less little fat. And you can even do things with some variety. For example, not only your chicken, but fish, dried beans, tofu, those sorts of things. Offering, in terms of fruits and vegetables, a colorful variety. With young kids, you can start to teach the colors of the rainbow with the fruits and veggies. You mentioned fruit juice earlier. So, that one does limit in terms of the recommendation on how much children can have as they grow older, For example, ages one to three, ideally no more than four ounces per day. From ages four to six, no more than four to six ounces per day. And then once they get over like seven years or so, ideally no more than eight ounces of fruit juice per day.

And some other food groups just to touch on is for grains. Ideally having the whole grains, not so much your white bread. You should focus more on finding the whole grain bread or whole grain pastas, brown rice instead of white rice. And also, being mindful of cow's milk that we're feeding our children and the amount that we're giving. For example, between ages one to two, it should be whole milk and it should be at least two cups per day. From two to eight years, that's going to be more of your fat-free or low-fat milk per day, about two to three cups per day. And after age nine, about at least three cups of fat-free or low-fat milk per day, just to name a few examples.

Melanie Cole, MS: That was excellent. So, it's really great information that parents need to hear. Now, what about physical activity? What role does that play and where do parents come in with that? Because Dr. Lin, as we notice things changing around the country and some schools are cutting some things, gym and recess. But parents have to play that role in getting their kids physically active, maybe extramural sports, extracurricular activities. Tell us a little bit about where physical activity comes into play here.

Dr. Amanda Lin: Yeah, just like I mentioned how early nutrition can last into adulthood, there's also evidence that physical activity patterns that you kind of build into childhood do continue into adulthood, building those healthy habits. So, infants and preschool age parents should basically allow for limited active playtime in a safe and supportive environment. And then, once they start reaching your elementary school age, like over five years old or so, definitely emphasize at least 60 minutes of moderate to vigorous activity per day.

Another point is to have decreased screen time, especially in this day and age, to have ideally no more than two hours of screen time per day, and especially for kids younger than two years old. That would be including activities as a family, like not having regular TV time together, less than, you know, two to four years of age, not having the TV inside of the child's room, and Ideally focusing on more quality programming per day and more interactive things that the parent can kind of show things with their child.

And of course, as a child gets older, building the physical activity into the daily routine and finding sports and activities that they enjoy. If they can join like a children's sports league or finding school after school activities, those sorts of things, that's definitely some of the best activities, ideally something year-round that they enjoy doing and that they can continue into adulthood.

So with all of those above food groups, you might also consider things like what should the proportion be on the plate. My Plate is a great resource for parents to kind of see what the ideal portion size. And as my parents know, one of my favorite words is moderation, especially when it comes to those delicious treats and things like that. Ideally, just not too much, just here and there in moderation.

Melanie Cole, MS: Dr. Lin, what we've been seeing in the past 10, 20 years is an obesity epidemic with our children. They did not used to have so much diabetes. We're seeing high blood pressure and it used to be called adult-onset. Now, we're seeing it in children as young as nine. Type two diabetes. Tell us a little bit about how the obesity epidemic, the sedentary lifestyle, these things we're talking about are contributing to late in life heart health problems in our children.

Dr. Amanda Lin: Yeah. This is definitely an important topic, so thanks for bringing this up. Data, like you mentioned, has shown that one in five children, according to the CDC, is affected by obesity now. So, that's about 14 million children. This is from data between 2017 to 2020. But we have also seen that obesity is a disease that can be treated. You should treat it like a biological condition, such as you would treat asthma, and kind of try to address factors that might affect. this. Factors such as what we had discussed earlier, like healthy eating and exercise, but there's so many other factors that can influence obesity. For example, social determinants of health and access to food, things such as stress, and also, of course, things like genetics and family history.

And like you mentioned, you know, we've been seeing a huge increase of things like high cholesterol, diabetes, blood pressure issues, joint problems, sleep apnea, just to name a few. Ideally, if we're able to address these things early on, these things won't come up in adulthood and hopefully won't continue into adulthood if we do see them in the child.

I also do want to mention how important it is to, focus on body positivity and try to have a positive mindset and encouraging mindset and non-judgmental point-of-view as a parent when it comes to our children, especially if they are dealing with obesity and its ramifications and ideally more of a focus on health and not as much about body appearance. If you do find yourself in the position that you're worrying about obesity in your child or some of these other issues I mentioned, feel free to talk with your pediatrician if you have concerns. And Weill Cornell Medicine even has a pediatric obesity program too, that's another additional resource.

Melanie Cole, MS: Well, thank you. And that's such a great point about how we speak to our children and actually how we speak to ourselves. And when we look in the mirror, if we're going to talk about ourselves and negative self-talk and our kids hear that. And then, they can read into that. So, so it's a great point that you just made.

Now, what about some of the heart conditions that we've heard about with kids in sports? Sudden cardiac death. Are there screenings that you think are worthwhile to check for cardiac abnormalities in kids?

Dr. Amanda Lin: Yeah, that's a great question. So, screening actually starts as early as in the womb and at birth. For example, when a mother is going through pregnancy during their prenatal echoes, they do do fetal heart studies. So, we're able to see early if there's any major issue. And also before a child is discharged from the hospital nursery, there is a congenital heart screening that does also screen for other major congenital issues.

And then as a child grows through life and goes through their well child visits, the pediatrician is able to identify and manage any early risk factors for things that we mentioned, like obesity, blood pressure issues, insulin resistance. And also, every child is screened at least once in their childhood for high cholesterol. The timing and the interval is going to be determined by their pediatrician. But usually, between ages 9 to 11 for a healthy child with no risk factor, they're going to be checked for cholesterol at that age. And then, beyond that or before, that's again going to depend on what their pediatrician observes and what they would recommend.

And then, in terms of sudden cardiac death, that's something else that parents are often worried about. You hear about athletes who suddenly pass out on the field and have this or that significant heart issue. And the one that we most commonly hear about and is talked about is something called hypertrophic cardiomyopathy, which is basically a genetic mutation of the cardiac structure that causes an abnormality in the heart chamber. The signs and symptoms of that would include things like difficulty with breathing, with exertion; breathing issues with lying flat at night, chest pain with exertion, palpitations, fainting, lower extremity swelling. If you notice your child with any of these sorts of issues, go ahead and bring them up to the pediatrician or make an appointment.

 Something else to mention with hypertrophic cardiomyopathy is that it is genetically passed down through the family. So, talk with your pediatrician if you do know of a first-degree relative with a heart condition such as this one and they can determine what the best next steps would be.

And then, one last next item on the topic of screening is a pre-sports physical, where basically the pediatrician is going to be screening for symptoms and family history and do a physical exam to assess the overall cardiac health of a child. And then, one last area of screening is of course a pre-sports physical, which is often a requirement in elementary and middle school and high school age children before they can start recreational sports. And during these appointments, the pediatrician will do screening for those signs and symptoms I mentioned earlier, talk about family history, and of course do the physical exam to assess for heart health and also the overall child's health before starting sports.

Melanie Cole, MS: Dr. Lin, this is such important information. And thank you for telling us all these things. And as we get ready to wrap up, how can we as parents encourage our kids to eat healthy and exercise so these behaviors will last a lifetime? You've given us from babies and toddlers. But when our kids are starting to be tweens and teens, it's a little harder to get them going. And sometimes they will roll their eyeballs at us while they want to sit on their phones. And especially, COVID kind of accentuated a little bit of that. So, I'd like you to summarize how we can get our kids to eat healthy and exercise so that those behaviors are really what last a lifetime.

Dr. Amanda Lin: Yeah, that's so crucial. So, thanks so much for bringing that up. I definitely do think we really need to treat the family as a unit and lead by example from an early age so that they know what the norm is. The norm should be eating healthy and having daily activity and parents should really try to lead by example and try to have those healthy lifestyle choices of exercise and eating healthy from when the child is early and young.

For example, having healthy food choices available and encouraged, having the water pitcher on the counter, the fruit bowl stocked, leave the veggie snacks in plain sight, and try to like get rid of the other less healthy options from the home. Having things such as dedicated mealtimes around the family, around the table as a family, without a TV at the table, so everyone's focused, enjoying their food and being mindful of how much they're eating. Try to limit the fast food and take out those sorts of things. I mentioned moderation earlier. Ideally, this would be more in moderation and approach things from a positive mindset with positive reinforcement and encouragement. And of course, try to make things fun. You know, other things that we can do to make things fun, like playing tag or cooking together as a family, making it a fun activity, or having a rainbow shopping list and finding the colorful foods and trying to make the full rainbow in the shopping cart or on the dinner table. Having a walking scavenger hunt and getting out of the house and doing things together. And even something like starting a family garden so that kids can get outside, work together with their parents and build something together to have a healthy lifestyle.

Melanie Cole, MS: Great advice, Dr. Lin. Thank you so much for joining us. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcasts and Google Podcasts.

For more health tips, please visit weillcornell.org and search podcasts, and don't forget to check out Back to Health. So many great podcasts there. I'm Melanie Cole. Thanks so much for joining us today.

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