3. INTEGRATED CARDIOVASCULAR HEALTH SCHEDULE

Risk FactorAge
Birth to 12 mo1–4 y5–9 y9–11 y12–17 y18–21 y
Family history of early CVDAt 3 y, evaluate family history for early CVD: parents, grand parents, aunts/uncles, men ≤55 y old, women ≤65 y old; review with parents and refer as needed; positive family history identifies children for intensive CVD RF attentionUpdate at each nonurgent health encounterReevaluate family history for early CVD in parents, grandparents, aunts/uncles, men ≤55 y old, women ≤65 y oldUpdate at each nonurgent health encounterRepeat family-history evaluation with patient
Tobacco exposureAdvise smoke-free home; offer smoking-cessation assistance or referral to parentsContinue active antismoking advice with parents; offer smoking-cessation assistance and referral as neededObtain smoke exposure history from child Begin active antismoking advice with childAssess smoking status of child; active antismoking counseling or referral as neededContinue active antismoking counseling with patient; offer smoking-cessation assistance or referral as neededReinforce strong antismoking message; offer smoking-cessation assistance or referral as needed
Nutrition/dietSupport breastfeeding as optimal to 12 mo of age if possible; add formula if breastfeeding decreases or stops before 12 mo of ageAt age 12–24 mo, may change to cow's milk with 2% percentage of fat decided by family and pediatric care provider; after 2 y of age, fat-free milk for all; juice ≤4 oz/d; transition to CHILD-1 diet by the age of 2 yReinforce CHILD-1 diet messagesReinforce CHILD-1 diet messages as neededObtain diet information from child and use to reinforce healthy diet and limitations and provide counseling as neededReview healthy diet with patient
Growth, overweight/obesityReview family history for obesity; discuss weight-for-height tracking, growth chart, and healthy dietChart height/weight/BMI; classify weight-by BMI from age 2 y; review with parentChart height/weight/BMI and review with parent; BMI ≥ 85th percentile, crossing percentiles: Intensify diet/activity focus for 6 mo; if no change: RD referral, manage per obesity algorithmsChart height/weight/BMI and review with parent and child; BMI ≥ 85th percentile, crossing percentiles: Intensify diet/activity focus for 6 mo; if no change: RD referral, manage per obesity algorithms; BMI ≥ 95th percentile: manage per obesity algorithmsChart height/weight/BMI and review with child and parent; BMI ≥85th percentile, crossing percentiles: intensify diet/activity focus for 6 mo; if no change: RD referral, manage per obesity algorithms; BMI ≥ 95th percentile, manage per obesity algorithmsReview height/weight/BMI and norms for health with patient; BMI ≥ 85th percentile, crossing percentiles: intensify diet/activity focus for 6 mo; if no change: RD referral, manage per obesity algorithms; BMI ≥ 95th percentile, manage per obesity algorithms
BMI ≥ 95th percentile, manage per obesity algorithms
LipidsNo routine lipid screeningObtain FLP only if family history for CVD is positive, parent has dyslipidemia, child has any other RFs or high-risk conditionObtain FLP only if family history for CVD is positive, parent has dyslipidemia, child has any other RFs or high-risk conditionObtain universal lipid screen with nonfasting non-HDL = TC − HDL, or FLP: manage per lipid algorithms as neededObtain FLP if family history newly positive, parent has dyslipidemia, child has any other RFs or high-risk condition; manage per lipid algorithms as neededMeasure 1 nonfasting non–HDL or FLP in all: review with patient; manage with lipid algorithms per ATP as needed
BPMeasure BP in infants with renal/urologic/cardiac diagnosis or history of neonatal ICUMeasure BP annually in all from the age of 3 y; chart for age/gender/height percentile and review with parentCheck BP annually and chart for age/gender/height: review with parent; workup and/or management per BP algorithm as neededCheck BP annually and chart for age/gender/height: review with parent, workup and/or management per BP algorithm as neededCheck BP annually and chart for age/gender/height: review with adolescent and parent, workup and/or management per BP algorithm as neededMeasure BP: review with patient; evaluate and treat per JNC guidelines
Physical activityEncourage parents to model routine activity; no screen time before the age of 2 yEncourage active play; limit sedentary/screen time to ≤2 h/d; no TV in bedroomRecommend MVPA of ≥1 h/d; limit screen/sedentary time to ≤2 h/dObtain activity history from child: recommend MVPA of ≥1 h/d and screen/sedentary time of ≤2 h/dUse activity history with adolescent to reinforce MVPA of ≥1 h/d and leisure screen time of ≤2 h/dDiscuss lifelong activity, sedentary time limits with patient
DiabetesMeasure fasting glucose level per ADA guidelines; refer to endocrinologist as neededMeasure fasting glucose level per ADA guidelines; refer to endocrinologist as neededObtain fasting glucose level if indicated; refer to endocrinologist as needed
  • All algorithms and guidelines in this schedule are included in this summary report. RF indicates risk factor; RD, registered dietitian; ATP, Adult Treatment Panel III (“Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults”); JNC, Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; MVPA, moderate-to-vigorous physical activity; ADA, American Diabetes Association.

  • The full and summary reports of the Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents can also be found on the NHLBI Web site (www.nhlbi.nih.gov).