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15. Integrated Cardiovascular Health Schedule*

Risk factor

Age
Birth–12 m

Age
1–4 y

Age
5–9 y

Age
9–11 y

Age
12–17 y

Age
18–21 y

Family history (FHx) of early CVD 

 

At age 3 y, evaluate FHx for early CVD:  parents, grandparents, aunts/uncles, M ≤55 y, F ≤ 65 y.  Review with parents, refer prn.
(+) FHx identifies children for intensive CV RF attention.

Update at each nonurgent health encounter.

Reevaluate FHx for early CVD in parents, grandparents, aunts/uncles,
M ≤ 55 y, and
F ≤ 65 y.

Update at each nonurgent health encounter.

Repeat FHx evaluation with patient.

Tobacco exposure

Advise smoke-free home; offer smoking cessation assistance or referral to parents.

Continue active antismoking advice with parents.  Offer smoking cessation assistance and referral as needed.

Begin active antismoking advice with child.

Assess smoking status of child.
Active antismoking counseling or referral as needed.

Continue active antismoking counseling with patient.  Offer smoking cessation assistance or referral as needed.

Reinforce strong antismoking message.
Offer smoking cessation assistance or referral as needed.

Nutrition/diet

Support breastfeeding as optimal to age 12 m if possible.  Add formula if breastfeeding decreases or stops before age 12 m.

Age 12–24 m, may change to cow's milk with % fat per family and pediatric care provider.
After age 2 y, fat-free milk for all; juice ≤4 oz/d; transition to CHILD 1* Diet by age 2 y.

Reinforce CHILD 1* diet messages.

Reinforce CHILD 1* diet messages as needed.

Obtain diet information from child and use to reinforce healthy diet and limitations and provide counseling as needed.

Review healthy diet with patient.

Growth, overweight/
obesity

Review FHx for obesity → Discuss wt for ht tracking, growth chart, healthy diet.

Chart ht/wt/BMI à classify wt by BMI from age 2 y; review with parent.

Chart ht/wt/BMI and review with parent.
BMI ≥ 85th %ile, crossing %iles, intensify diet/activity focus x 6 m.  If no change → RD referral, manage per obesity algorithms.
BMI≥ 95th %ile, manage per obesity algorithms.

Chart ht/wt/BMI and review with parent and child.
BMI ≥ 85th %ile, crossing %iles, intensify diet/activity focus x 6 m.  If no change → RD referral, manage per obesity algorithms.
BMI ≥ 95th %ile, manage per obesity algorithms.

Chart ht/wt/BMI and review with child and parent.
BMI ≥ 85th %ile, crossing %iles, intensify diet/activity focus x 6 m.  If no change → RD referral, manage per obesity algorithms.
BMI ≥ 95th %ile, manage per obesity algorithms.

Review ht/wt/BMI and norms for health with patient.
BMI ≥ 85th %ile, crossing %iles, intensify diet/activity focus x 6 m.  If no change → RD referral, manage per obesity algorithms.
BMI ≥ 95th %ile, manage per obesity algorithms.

Lipids

No routine lipid screening.

Obtain fasting lipid profile only if FHx (+), parent with dyslipidemia, any other RFs (+), or high-risk condition.

Obtain fasting lipid profile only if FHx (+), parent with dyslipidemia, any other RFs (+), or high-risk condition.

Obtain universal lipid screen with nonfasting non-HDL = TC – HDL, or fasting lipid profile → Manage per lipid algorithms as needed.

Obtain fasting lipid profile if FHx (+), parent with dyslipidemia, any other RFs (+), or high-risk condition; manage per lipid algorithms as needed.

Measure nonfasting non-HDL-C or fasting lipid profile in all x 1 → Review with patient; manage with lipid algorithms/ATP as needed.

Blood pressure

Measure BP in infants with renal/urologic/ cardiac diagnosis or Hx of neonatal ICU.

Measure annual BP in all from age 3 y; chart for age/gender/ht %ile and review with parent.

Check BP annually and chart for age/gender/ht → Review with parent; work up and/or manage per BP algorithm as needed.

Check BP annually and chart for age/gender/ht → Review with parent, work up and/or manage per BP algorithm as needed.

Check BP annually and chart for age/gender/ht → Review with
adolescent and parent, work up and/or manage per BP algorithm as needed.

Measure BP → Review with patient.  Evaluate and treat as per JNC 7 guidelines.

Physical activity

Encourage parents to model routine activity.  No screen time before age 2 y.

Encourage active play; limit sedentary/ screen time to ≤ 2 h/d.  No TV in bedroom.

Recommend MVPA ≥ 1h/d; limit screen/sedentary time to ≤ 2 h/d.

Obtain activity Hx from child à recommend MVPA ≥ 1 h/y; screen/sedentary time ≤ 2 h/d.

Use activity Hx with adolescent to reinforce MVPA ≥ 1 h/d, leisure screen time ≤ 2 h/d.

Discuss lifelong activity, sedentary time limits with patient.

Diabetes

   

   

   

Measure fasting glucose per ADA guidelines, refer to endocrinologist as needed.

Measure fasting glucose per ADA guidelines, refer to endocrinologist as needed.

Obtain fasting glucose if indicated, refer to endocrinologist as needed.

* The Full and Summary Report of the Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents also may be found on the NHLBI Web site:  http://www.nhlbi.nih.gov/


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