Children with a higher body mass index and blood pressure have a greater risk of cardiovascular disease, pointing to the need for prevention and education at early ages.
Laura L. Hayman, PhD, RN, FAAN, researcher and professor at the College of Nursing and Health Sciences at the University of Massachusetts Boston refers to the Journal of the American College of Cardiologys Oct. 14 online article, Impact of Long-Term Burden of
Excessive Adiposity and Elevated Blood Pressure From Childhood on Adulthood Left Ventricular Remodeling Patterns, which confirms the findings of the four-decade Bogalusa Heart Study, which concluded childhood obesity and hypertension result in left ventricular remodeling in adulthood.
The latest research shows that the processes that contribute to CVD begin early in life and accelerate over time, Hayman said. Several lines of evidence show early intervention in childhood can change CVD risk, she said.
Nancy Hagberg, MS, RN, FNP, provides primary care for children and adolescents at Child Heart Associates in Worcester, Mass.
We should start prevention and education in childhood because healthy and unhealthy habits start during childhood, and we want to have as much time as possible to establish health habits, Hagberg said.
Hagberg sees a variety of children and youth who are at risk for CVD as adults. As she assesses patients and their lifestyles, she involves the whole family in the intervention and education process, which often centers on weight and food choices.
I want the whole family to come to appointments so we can go over behaviors that help to cut down on overeating, she said, adding the person who buys the households food should come, too. Often its the dad whos purchasing food, so he needs to hear our discussion and review the childs food intake.
Hagberg said to make lifestyle changes that last for life, she often begins working with children with obesity at ages 4 or 5.
For every risk factor left untouched in childhood, theres a cascading effect through the lifetime, said Mary Caselton BSN, RN-BC, who works at The Heart Center at Ann & Robert H. Lurie Children’s Hospital of Chicago.
Caselton said that in the past, blood pressure was not checked often in young children because typically they were not diagnosed with essential hypertension.
She said baseline screening of children should begin by age 10 with a non-fasting cholesterol level, based on 2011 national guidelines from the National Heart, Lung and Blood Institute and endorsed by the Academy of Pediatrics.
Nurses need to be aware of the current integrated guidelines and encourage their uptake in practice, Hayman said. The early cholesterol screening identifies children at risk for later CVD. If you have an obese child, you need to assess the whole risk factor profile.
In addition to making accurate assessments, nurses can involve families and children in their own care. Hagbergs assessment includes the patient and family. She asks children to find their place on the growth chart based on her assessment, and directs older children to manually plot their height and weight.
I give them a calculator and ask them to calculate their BMI, then see where they are on the graph, she said.
Hagberg also asks children to fill out a worksheet, assigning a happy, sad or neutral face to their LDL and HDL values. This gives them more power over the numbers, she said.
Applying the nursing process also means considering psychosocial aspects and cultural elements, and pulling in other disciplines, such as social workers, Caselton said. I recently had a family in for a repeat visit, and I couldnt figure out why they couldnt make the needed dietary changes, she said. Then she discovered the family has no refrigerator, so fresh foods are impractical.
Caselton said lifestyle changes to reduce CVD requires getting the patient on board. Older children and adolescents can be very resistant to change, so a strong knowledge of psychosocial development is important. She said success with these situations comes when the nurse waits for the teachable moment, then steps in to make a contract with the patient who must take ownership of the change.
Taking a population-based approach is another way nurses can improve prevention and education at early ages, Hayman said.
Get involved in the advocacy arena, she said. Seek policies and legislation that can use support, such as the Healthy Hunger-Free Kids Act. Lobby to increase awareness. Hayman added nurses can offer to give classes at community schools. Link up with school nurses to get the message out in ethnically and culturally appropriate ways, she said.