By: S. Kristen Sexson Tejtel, MD, PhD, FAAP & MPH, FAAP & Alan Riley, MD, FAAP
Congenital heart disease is the term for defects that affect the heart that are present at birth (congenital). If your child has congenital heart disease, this means there's a problem with their heart's structure or the way it works.
There are many different types of congenital heart disease. Some are simple and don't need to be treated. Others are more complex and may need medication or surgery.
Why congenital heart disease puts kids at increased risk for obesity
Children who have congenital heart disease are at a higher risk of having overweight and obesity. There are several reasons for this, including:
Needing more calories in early life: Babies with congenital heart disease tend to have a hard time gaining weight, since they burn more energy breathing faster and trying to eat. To help them grow, they're given high-calorie formula or supplements. But after surgery or over time as their child's symptoms get better, parents often keep using the same higher-calorie feedings.
Having common risk factors: Studies show that certain groups of kids are more at risk for obesity, including those who:
- have a body mass index (BMI) between the 85th and 95th percentiles
- have a family history of obesity in one or both parents
- gain weight faster than they grow in height at a young age OR whose BMI increased quickly before age 7 years old
- have excessive weight gain in adolescence
- were very active and have become inactive
- are inactive in general, especially adolescents
Many kids with congenital heart disease fall into one or more of these groups.
Exercise restrictions: In the past, doctors used to limit physical activity for kids and teens with congenital heart disease. Unfortunately, kids who begin an inactive lifestyle are more likely to stay that way. Now experts know that exercise and active play has many benefits and it's safe for most children with congenital heart disease. Even when it's doctor-approved, parents may worry about how exercise will affect their child. It can also be hard for kids who were told at first to limit their activity to get moving.
Maintaining a healthy weight
Your pediatrician will monitor your child's weight to make sure they're staying in a healthy range. If your child is gaining weight too fast, your doctor will talk to you about making some lifestyle changes. This includes changes in diet, exercise, and reducing inactivity.
Eating a healthy diet
Dietary recommendations for kids and teens with CHD are the same as for any child. Keep these guidelines in mind when you plan meals.
Increase your child's dietary fiber to at least 14 g for every 1000 calories eaten. Foods that contain fiber include:
Fresh fruits and vegetables
Whole-grain foods such as brown rice, whole-grain pasta, corn, peas, and breads
Decrease your child's intake of dietary fat to less than 30% of their daily calorie intake. There are some simple ways to cut fat such as:
Choose lower-fat or fat-free toppings like grated low-fat Parmesan cheese, salsa, herbed cottage cheese, nonfat/low-fat gravy, low-fat sour cream, low-fat salad dressing, or yogurt.
Select lean meats such as skinless chicken and turkey, fish, lean beef cuts (round, sirloin, chuck, loin, and lean ground beef with no more than 15% fat content) and lean pork cuts (tenderloin, chops, ham). Buy "choice" or "select" grades of beef rather than "prime." Trim off all visible fat. Remove skin from cooked poultry before eating.
Include healthy oils such as canola or olive oil in your child's diet. Choose vegetable oils without trans fats made from canola, corn, sunflower, soybean, or olive oils.
Use nonstick vegetable sprays when cooking.
Stick to fat-free cooking methods such as baking, broiling, grilling, poaching, or steaming when cooking meat, poultry, or fish.
Limit cholesterol to less than 300 mg daily. That means limiting full fat dairy, red and processed meat, fried foods, and baked goods.
Limit sodium to less than 2500 mg daily.
Eliminate or limit sugar-sweetened beverages to less than 4 ounces per day. Encourage your child to drink water instead.
Get familiar with actual serving sizes. For example, one piece of bread is one serving, not two (even though we use two for sandwiches).
Nutrition Facts label on food packages to find foods with less saturated fat per serving. Pay attention to the serving size as you make choices. Remember that the percent daily values on food labels are based on portion sizes and calorie levels for adults. You'll need to adjust for your child.
All kids and teens, including those with congenital heart disease, should regularly participate in physical activity or sports. Medical professionals recommend that children do 60 minutes of physically active play or sports per day, every day.
Regular physical activity helps prevent weight gain and early-onset adult heart disease such as heart attacks and strokes. Many studies show that exercise can also help prevent diabetes, high blood pressure and high cholesterol. Most children with congenital heart disease live well into adult life. But when you have congenital heart disease, your heart may be more easily damaged by obesity, high blood pressure and diabetes. This is why regular exercise is so important for everyone with congenital heart disease.
The majority of children with congenital heart disease don't need physical activity restrictions. However, some do. If your child is taking blood thinners or they have fragile implantable devices, abnormal heart rhythms, depressed heart function or decreased blood flow to the heart during exercise, their doctor may recommend restricting certain activities.
Your pediatric cardiologist can advise you on the best physical activities for your child at your visits, even if activity restrictions are needed. Be sure to check with your cardiologist before your child starts a new sport or exercise routine.
How to make activity a priority
Daily physical activity is essential for everyone, including kids and teens with congenital heart disease. Here's how you can improve your child's activity levels:
Make sure your child gets at least an hour of moderate to vigorous activity every day. They should engage in vigorous activity at least 3 days a week.
Limit total screen time (computer, video game, TV, tablet, smart phone, etc.) to no more than 2 hours of quality programming per day.
Keep TVs, electronics and screens out of your child's bedroom.
Support the recommendations for daily physical education at your child's school.
Create an active lifestyle
In today's busy world, it's harder and harder for children to play and run outside on a daily basis. That makes organized sports and exercise activities good options. Let your child participate in choosing an activity or sport to try. If they enjoy it, they'll want to keep doing it.
Planning activities with friends can also encourage your child to stay active. Team sports are a great way to get exercise with friends. Getting family members involved can go a long way too. Take family walks, hikes or bike rides. Do a workout video or stretches together. Put on a fun dance video game. Try family bowling, roller skating, or laser tag.
Wearable step counters or heart rate monitors are another way to make exercise fun. Most devices allow you to set goals. This encourages more physical activity. Your child may be inspired to see how many steps they've walked in a day or how long their heart was elevated during a workout.
Remember that sports and exercise should be fun. Kids will be more likely to get exercise or participate in sports that they enjoy. The goal is to build a life-long habit of regular exercise. Forcing exercise that your child doesn't like or doesn't find rewarding won't last. Be creative and find ways to get out there and have fun with exercise.
About Dr. Sexson Tejtel
S. Kristen Sexson Tejtel, MD, PhD, MPH, FAAP, is a pediatric cardiologist with interest in cardiac imaging and acquired heart disease in children. Within the American Academy of Pediatrics, Dr. Sexson Tejtel is a member of the Section on Cardiology and Cardiac Surgery Publications and Communications Committee.
About Dr. Riley
Alan Riley, MD, FAAP, a pediatric cardiologist at Texas Children's Hospital/Baylor College of Medicine, is a member of the American Academy of Pediatrics Section on Cardiology and Cardiac Surgery.