Table 16A. Guidelines for Cardiovascular Health Promotion in All Children and Adolescents

Health Promotion Goals Recommendations Diet •  An overall healthy eating pattern •  Appropriate body weight •  Desirable lipid profile •  Desirable blood pressure     •  Assess diet at every visit. •  Match energy intake with energy needs for normal growth and development. •  Make appropriate changes to maintain a healthy weight and achieve weight loss when indicated. •  Advocate consumption of a variety of fruits, vegetables, whole grains, dairy products, fish, legumes, poultry, and lean meat. •  Fat intake is unrestricted prior to 2 years of age. After age 2, limit foods high in saturated fats (<10% of calories per day), cholesterol (<300 mg per day), and trans fatty acids. •  Limit salt intake to <6 g per day. •  Limit intake of sugar. Smoking •  No new initiation of cigarette smoking •  No exposure to environmental tobacco smoke •  Complete cessation for those who smoke   •  Question tobacco use by parents at every visit. •  Question tobacco use by children, starting at age 10, at every visit. •  Provide clear, strong, informed, and personalized counseling against initiation of smoking. •  Advise avoidance of second-hand smoke at home, with friends, at school, or at work. Physical Activity •  Be physically active every day •  Reduce sedentary time (eg television watching, computer, video games, or time on the phone)   •  Assess physical activity at every visit. •  Advise young people to participate in at least 60 minutes of moderate to vigorous physical activity every day. •  Physical activity should be fun for children and adolescents. •  For adolescents, resistance training (10 to 15 repetitions at moderate intensity) can be combined with aerobic activity in an overall activity program. •  Sedentary time should be limited. For example, limit television time to at most 2 hours per day.

Kavey REW, Daniels SR, Lauer RM, Atkins DL, Hayman LL, Taubert K. American Heart Association Guidelines for Primary Prevention of Atherosclerotic Cardiovascular Disease Beginning in Childhood. Circulation. 2003;107:1562-1566.






Table 16B. Daily Estimated Calories* and Recommended Servings for Grains, Fruits, Vegetables, and Milk/Dairy

1 Year 2–3 Years 4–8 Years 9–13 Years 14–18 Years  Calories†     Female     Male    900 kcal  1000 kcal    1200 kcal  1400 kcal    1600 kcal  1800 kcal    1800 kcal  2200 kcal  Fat  30%–40% kcal   30%–35% kcal   25%–35% kcal   25%–35% kcal   25%–35% kcal   Milk/dairy‡  2 cups¶  2 cups  2 cups  3 cups  3 cups  Lean meat/beans       Female     Male  1.5 oz  2 oz    3 oz  4 oz  5 oz    5 oz  6 oz  Fruits§     Female     Male  1 cup  1 cup  1.5 cups  1.5 cups    1.5 cups  2 cups  Vegetables§     Female     Male  ¾ cup  1 cup    1 cup  1.5 cups    2 cups  2.5 cups    2.5 cups  3 cups  Grainsll     Female     Male  2 oz  3 oz    4 oz  5 oz    5 oz  6 oz    6 oz  7 oz

*Calorie estimates are based on a sedentary lifestyle. Increased physical activity will require additional calories: by 0-200 kcal/d if moderately physically active; and by 200–400 kcal/d if very physically active.

^†For youth 2 years and older; adopted from Table 2, Table 3, and Appendix A-2 of the Dietary Guidelines for Americans (2005); http://www.healthierus.gov/dietaryguidelines. Nutrient and energy contributions from each group are calculated according to the nutrient-dense forms of food in each group (eg lean meats, and fat-free milk).

^‡Milk listed is fat-free (except for children under the age of 2 years). If 1%, 2% or whole-fat milk is substituted, this will utilize, for each cup, 19, 29, 94 63 kcal of discretionary calories and add 2.6, 5.1, or 9.0 g of total fat, of which 1.3, 2.6, or 4.6 g are saturated fat.

^§Serving sizes are ¼ cup for 1 year of age, 1/3 cup for 2 to 3 years of age, and ½ cup for >4 years of age. A variety of vegetables should be selected from each subgroup over the week.

^llHalf of all grains should be whole grains.

^¶For 1-year-old children, calculations are based on 2% fat milk. If 2 cups of whole milk are substituted, 48 kcal of discretionary calories will be utilized. The American Academy of Pediatrics recommends that low-fat/reduced fat milk not be started before 2 years of age.

Gidding SS, Dennison BA, Birch LL, et al. Dietary recommendations for children and adolescents: a guide for practitioners. Consensus statement from the American Heart Association. Circulation. 2005;112:2061-2075.






Table 16C. Tips for Parents to Implement AHA Pediatric Dietary Guidelines

•  Reduce added sugars, including sugar-sweetened drinks and juices •  Use canola, soybean, corn oil, safflower oil, or other unsaturated oils in place of solid fats during food preparation •  Use recommended portion sizes on food labels when preparing and serving food •  Use fresh, frozen, and canned vegetables and fruits and serve at every meal; be careful with added sauces and sugar •  Introduce and regularly serve fish as an entrée •  Remove the skin from poultry before eating •  Use only lean cuts of meat and reduced-fat meat products •  Limit high-calorie sauces such as Alfredo, cream sauces, cheese sauces, and hollandaise •  Eat whole grain breads and cereals rather than refined products; read labels and ensure that “whole grain” is the first ingredient on the food label of these products •  Eat more legumes (beans) and tofu in place of meat for some entrées •  Breads, breakfast cereals, and prepared foods, including soups, may be high in salt and/or sugar; read food labels for content and choose high-fiber, low-salt/low-sugar alternatives

Gidding SS, Dennison BA, Birch LL, et al. Dietary recommendations for children and adolescents: a guide for practitioners. Consensus statement from the American Heart Association. Circulation. 2005;112:2061-2075.






Figure 16. Food Guide Pyramid for Young Children

Food Guide Pyramid for Young Children. U.S. Department of Agriculture and the U.S. Available at: http://www.usda.gov/cnpp/KidsPyra/. Accessed on September 29, 2005.