The Heart of the Matter

By Kandice Mah, MD on February 28, 2011
The staff at SickKids Hospital have their finger on the pulse of children’s health.

Over the past year, Dr. Lee Ford-Jones of Social Pediatrics and Dr. Brian McCrindle, pediatric cardiologist, along with pediatric resident Dr. Kandice Mah, have compiled information about healthy living in childhood and the impact it has on future adult cardiovascular health, intelligence and opportunity. Their experience has been that parents often face a lot of pressure about what to do and what not to do when it comes to their children. In their search to share their findings with parents, they turned to ParentsCanada.

In medicine you see firsthand the heartache many families endure as they watch their loved ones battle illness. My most vivid memory as a medical student was that of 70-year-old Mr. A., who survived a life changing experience in January 2009.

“I began to experience shortness of breath, and it was extremely frightening,” he recalls. “I was gagging and attempting to draw in as much air as possible. Fortunately my wife was home, and called 911.” After rushing her husband to the hospital Mrs. A. remembers the moment when she realized the significance of the day. “I was shocked at the size of the team working on him and the amount of equipment surrounding him. This was my first indication that this was really serious.”

This family’s experience drove me to find out more about cardiovascular disease as I started my pediatrics residency.
Although heart attacks are extremely rare in children, Dr. Michael Froeschl, interventional cardiologist at the University of Ottawa Heart Institute, recognizes the benefit of addressing heart health in childhood. “Most of the modifiable risk factors are related to lifestyle which has its roots in childhood, and because diet and exercise in turn have a major impact on all of the
medical risk factors, it makes far more sense to begin addressing these at a younger age.” In short, the choices parents make today can impact our children’s risk of developing heart disease as an adult.

A father of three children under the age of six, Dr. Froeschl has his hands full. “When they’re that small, you have so much control over their lives, so the risk factors for obesity (a cause of heart disease) aren’t as threatening: they eat most of their meals at home and the rest at school or daycare (which are quite healthy – my wife and I check). They are running around all the time, and they’re not yet into bad habits such as junk food, video games and smoking.”

Dr. Froeschl admits there is one risk factor they do struggle with: sodium. “Only a small amount of our daily sodium intake comes from the salt shaker, so reading food labels at the grocery store is so important. But that can seem an impossible task with a screaming baby on your arm, a toddler whining because he’s bored and a five-year-old who needs to use the bathroom.”
Dr. Brian McCrindle, pediatric cardiologist at SickKids, has dedicated much of his career to promoting cardiac health in children. He says that the buildup of heart damaging plaque in children is more reversible with less aggressive methods, but in an adult, that plaque is hardened and is difficult to break down The statistics of children’s health today are alarming:
  • only 13 percent of children over five meet the Canadian guideline of 90 minutes a day of physical activity.
  • less than 20 percent of children follow the Canadian Pediatric Society Guideline of less than two hours per day of screen time.
  • more youth are smoking.
  • there is a substantial intake of processed and fast foods.
It is no wonder then that Statistics Canada reports an increase in overweight and obese 6- to 11-year-olds, from 13 percent in 1979 to 27 percent in 2004. And similarly, it shouldn’t come
as a surprise that more young people are being diagnosed with cardiovascular disease, diabetes, obesity, high cholesterol, and high blood pressure.
The rise in childhood obesity has spurred a multitude of initiatives. Yet many parents feel they are left with more questions than answers and more barriers than support. So how and when
should a parent start addressing healthy habits?

Start Early
Ideally, good heart health begins from conception. Twenty years ago, Dr. David Barker proposed that malnutrition in the womb impeded heart cell maturation and proper development of
heart chambers. Since then, research has confirmed that early malnutrition can permanently alter the body and lead to later disease. Interestingly, malnutrition not only involves the gestational
period but is in fact influenced by the lifetime nutrition of young women before they become pregnant. Thus optimal growth in childhood can modify the health of future generations.
The “First Five Years of Life” campaign has raised awareness of the impact of this time on children’s futures. But middle childhood, ages 6 to 12, has often been thought of as the “forgotten years.” This is a period of great change. Children become taller, stronger, more agile, expressive, abstract in their thinking, and more aware of the world around them. The opportunity to make the most of this potential is exciting. With respect to instilling healthy living habits – particularly physical activity – during this age, this means children not only benefit by becoming cardiovascularly more healthy but they also:
  • Improve motor skills: The brain in middle childhood undergoes differential growth based largely on the activities to which a child is exposed, thus by emphasizing physical literacy at this time, the brain becomes more hardwired to help children reach their potential in performing these skills.
  • Improve self esteem: Children develop resilience and security through the positive social interactions, critical thinking, adaptability and sense of competence offered by physical activity.
  • Promote positive mental health: Studies have shown that the stability and positive friendships cultivated through physical activity acts as a protective factor for children at risk of   behavioral and emotional problems.
  • Enhance academic performance: Physical activity produces biological substances that protect the brain and improve memory, concentration, and attention. In addition, the self-esteem and decreased misconduct enables students to focus and gives them the motivation to try harder.  Hence, their environments, opportunities and relationships provided by physical activity in middle childhood can foster knowledge and proficiencies that prepare children to not only be healthier adults but also more competent and prepared adults.
RECREATION
There are many benefits to being physically active. Unfortunately, for many of us our fast-paced lifestyle makes it easier to choose fast foods, desserts and television over cooked meals and activity.
Families are up against a lot:
  • commercial promotion of unhealthy foods, drinks, activities, and smoking;
  • lack of information about what constitutes balanced meals;
  • personal difficulties making healthy choices;
  • language and financial hurdles;
  • inaccessibility to activity;
  • unsafe neighbourhoods.
Communities and governments play a pivotal role in removing these barriers to healthy living. Resources must be focused on creating facilities for physical activity, health-conscious lunch programs, accessible and affordable foods in all areas of the country, safer parks, and recreational access for the disabled. By investing in these, communities and governments assist in decreasing violence, improving child development, and nurturing healthier individuals. In the long run these investments pay off. For every dollar that is put into physical activity; there is a
long-term savings of $11 in health care cost.
Yet not all of the responsibility for our health lies with governments. No matter how many resources are available, the greatest impact on current and future health starts at home. “In improving the cardiovascular fate of children, parents have an important role to play,” says Dr. Froeschl. “First, they need to know the constituents of a heart-healthy diet, and then ensure that their children are consuming one. Second, they should promote from an early age their children’s participation in physical activity. Finally, they need to aggressively advocate smoking abstinence. Crucially, parents must understand that they are role models for their children.”

EASIER SAID THAN DONE
With kids, it can be a battle to do what is in their best interest. However, I have found that starting small helps. We don’t want children to feel restricted by healthy living; instead as they reap
the physical and developmental benefits of physical activity and a varied diet, they often find that they enjoy it. Simple changes to boost activity can include:
  • decreasing screen time and supplementing it with a walk after dinner
  • dancing in the living room
  • taking the stairs instead of the elevator
  • parking farther away from the front door in a parking lot
  • walking to school or playing in the back yard.
Children who have active parents and active peers are more likely to be active themselves. Routine is also a big part of childhood, so making physical activity consistent will give kids a chance to be naturally active. You will figure out what works best for your family, and you may surprise yourself in discovering talents and interests you did not know you or your children possessed. You can also make minor changes to meals. Start with smaller portions, a few more cooked meals, special dessert days and choosing milk or fresh fruits over sugary drinks. Getting your kids to help make meals teaches them the benefits of heart-healthy eating, while exposing them to new foods and practical skills. Most of all, by engaging them they are more likely to adopt the changes. The aim is to eat right about 70 percent of the time – this allows for special occasions and outings. From this, children will learn to make their own healthy food choices without feeling deprived or guilty. Combined with increased activity, children will have the tools and flexibility to have a variety of foods they enjoy.
We all have a role to play in shaping the health and development of each child, from government heads, business leaders, media and commercial outlets to coaches, teachers, health care workers and parents. Only together can the message of heart-healthy living be conveyed and acted upon effectively for the next generation.The key is moderation, starting small, starting young and moving forward.
Through structure, modeling, education and exposure of children to different experiences, we can concurrently give them the foundation to create healthier and happier lives – which ultimately is every parent’s desire.



Published in March 2011.

Dr. Kandice Mah is in the second of four years of her pediatrics residency at the University of Toronto. She hopes to one day help shape the health of children by influencing their lifestyle.

By Kandice Mah, MD| February 28, 2011

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