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  • Denise Scott

Heart Health Guidelines per the American Heart Association and the American Academy of Pediatrics

Updated: Apr 24, 2023

Guidelines for heart health and cardiovascular risk reduction have been set forth by the American Academy of Pediatrics (AAP) and the American Heart Association (AHA). This article will highlight and summarize these recommendations.



Although cardiovascular disease is considered an adult disease, the risk factors, and behaviors for developing this begin in childhood.

Cardiovascular health guidelines were developed for pediatrics to identify and manage risk factors and prevent risk-factor development from ages birth to twenty-one.


Risk factors include:

  • Family history

  • Age

  • Gender

  • Nutrition/diet

  • Physical inactivity

  • Tobacco exposure

  • Blood pressure

  • Lipid levels

  • Overweight/obesity

  • Diabetes mellitus

  • Predisposing conditions

  • Metabolic syndrome

  • Inflammatory markers

  • Perinatal factors


The recommendations for various age groups for pediatricians and physicians seeing children are outlined below.


Birth to 12 months:

Obtain family history for obesity and track growth

Screen for tobacco exposure in the home

Support breast or formula feeding for the first 12 months


1-4 years:

Obtain family history for any early cardiovascular disease (CVD) in relatives (men under 55 or women under 65)

Give anti-smoking and tobacco exposure advice

Track growth and BMI (body mass index)

Nutrition advice includes changing to 2% milk between 1 and 2 and changing to fat-free milk after age 2

Measure blood pressure (BP)

Obtain baseline fasting lipid panel IF family history positive for early CVD

No screen time under age 2


5-9 years:

Review family heart history

Review smoking/tobacco exposure

Track growth and BMI and address concerns

Measure BP

Limit screen time to less than 2 hours daily

Encourage physical activity

Fasting lipid panel if positive family history


9-11 years:

Review family history

Assess smoking status (in child and family)

Track growth and BMI, dietary advice as needed

Measure BP

Assess screen time and activity level

Baseline lipid panel, if not done previously


12-17 years:

Upgrade family history

Assess for smoking and tobacco exposure

Track growth and BMI, review eating habits with the patient, counseling as needed

Measure BP

Obtain lipid panel and fasting blood sugar if indicated


18-21 years:

Review family history

Assess smoking status and tobacco exposure

Track growth and BMI, review dietary habits, counseling as needed

Measure BP

Obtain lipid panel

Fasting blood sugar as indicated


The above recommendations are based on the evidence that early screening and intervention can make a difference in the development of heart disease, based on the knowledge that atherosclerosis begins in childhood. These guidelines are based on the risk factors for children with a family history of early CVD, high BP, obesity, diabetes, passive or active smoking, and high lipids.



The American Heart Association (AHA) gives further guidance for a heart-protective lifestyle.

  1. Adjust energy intake and expenditure to achieve and maintain a healthy body weight. Strive for 60 minutes of physical activity/exercise a day.

  2. Eat fruits and vegetables every day in a variety of colors, especially dark green, orange, and yellow.

  3. Choose whole-grain foods and products rather than refined grains. Look for “whole grain” as the first ingredient on the food label of these products and choose a variety.

  4. Choose healthy sources of protein: plants, fish and seafood, and low-fat or fat-free dairy products. If meat or poultry is desired, choose lean cuts and unprocessed forms. Eat more legumes (beans) and tofu instead of meat for some entrées.

  5. Eat foods low in saturated fat and cholesterol, and limit processed meat. Try to choose the following foods:

    1. Lean meats, fish, and meat alternatives like beans or tofu

    2. Unsaturated fats, like canola oil, olive oil, avocado, and nuts.

  6. Choose minimally processed foods instead of ultra-processed foods.

  7. Minimize the intake of beverages and foods with added sugars.

  8. Choose and prepare foods with little or no salt. Try to limit salt intake to less than 2000 mg daily.

  9. If you do not drink alcohol, do not start; if you choose to drink alcohol, limit the intake.

  10. Limit high-calorie sauces such as Alfredo, cream sauces, cheese sauces, and hollandaise

  11. Use recommended portion sizes on food labels when preparing and serving food.

  12. Adhere to this guidance regardless of where food is prepared or consumed.


Because evidence supports that cardiovascular disease is associated with added sugars and a high-sugar diet, the AHA recommends that:


Children younger than 2 should consume NO foods or drinks with added sugar and

Children, teens 2-18, and women should consume no more than 25 grams of added sugar a day. This is equal to 6 teaspoons of sugar, or about 100 calories.

They also recommend no more than 8 ounces of sugary beverages a week.


The AHA also recommends limiting salt intake in children and teens to 1500-1800 mg daily or about ½ -¾ teaspoon.


Sleep is crucial to reduce the risk of chronic disease, promote healing, and improve brain function. The AHA recommends the following by age:


4 to 12 months 12-16 hours (including naps)

1-2 years 11-14 hours

3-5 10-13 hours

6-12 9-12 hours

13-18 8-10 hours



The puzzle pieces to protecting the heart include:

  • a healthy diet with fruit, vegetables, whole grains, legumes, and unsaturated fatty acids

  • regular physical activity

  • maintain a healthy body weight

  • minimize added sugar

  • minimize saturated fats

  • decrease salt intake to less than 2000 mg a day

  • choose minimally processed foods

  • avoid tobacco products


As you can see, there are numerous steps you can take to protect your child’s heart starting now!



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