Risk factor
|
Age
Birth12 m
|
Age
14 y
|
Age
59 y
|
Age
911 y
|
Age
1217 y
|
Age
1821 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 1224 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.
|