Generally considered a disease that affects adults, a growing number of children are falling prey to the condition today. Here we look at the risk factors and how they can be prevented
Cardiovascular disease has been the largest cause of mortality in India for several years now. On the occasion of World Heart Day, Peadiatric Cardiologist, Dr Sushil Azad tells us about the conditions that lead to heart disease in children and how it can be prevented.
Heart disease in children can develop from abnormalities that involve structure, function or rhythm of the heart. Based on these abnormalities, a child can have the following types of heart disease:
1. Congenital malformation: This is the most common type of heart disease in children. Holes, valve blocks and abnormal connections between various chambers occur when the heart is developing in foetal life.
Implications: A child with congenital heart defects may reach developmental milestones more slowly than healthy children. The article, 'Growth and Development in Children with Congenital Heart Disease,' published in Stanford Children's Health states that a child with congenital heart disease may require frequent hospitalisation, which may prevent him from growing as a normal child does. Complications related to education, travel, and marriage and child-bearing capacity may develop as the child grows into an adult. Regular follow-ups with a healthcare centre for medication and therapies are a must.
2. Cardiomyopathy: In some children, the function of the heart is reduced due to viral infection or genetic disorder. This condition causes disorders of cardiac rhythm including fast heart rate (tachyarrhythmia) or slow heart rate (bradyarrhythmia or heart block). It occurs due to abnormally conducting fibres in the heart.
Implications: A child with cardiomyopathy may experience feelings of palpitations (fluttering) in the chest. The website, Cardiomyopathy.com states that, despite medications, arrhythmia can be life-threatening at times. As children with this condition grow, they may have to make lifestyle changes. They may be required to avoid strenuous exercise, follow specific dietary guidelines and have regular check-ups. Cardiomyopathy may limit the ability to drive safely. A woman with this condition must consult a doctor before she plans to have a baby as advanced pregnancy increases the workload of the heart.
With every passing year, the incidence of heart disease among children has grown due to an increase in the prevalence of risk factors. Lifestyle, family history, age and existing health conditions also play may also increase the risk for heart disease in children.
It is estimated that 7 to 10 per cent of school children in India suffer from hypertension and about 16 per cent have high cholesterol levels. Childhood stress is another risk factor for heart disease. The severity and duration of stress lead to the development of hypertension, obesity, diabetes and coronary artery disease in the child as he grows.
These risk factors can be lowered by making changes in lifestyle such as eating heart-healthy food, increasing the level of physical activity and leading a stress-free life.
Let's look at how the risk factors can be modified with healthy lifestyle habits.
The concept of a balanced diet is most important to achieve a healthy heart. A balanced diet includes all the macronutrients, that is proteins, carbohydrates and fats in a proportion such that 40 per cent of energy is provided by carbohydrates, 30 per cent by proteins and 30 per cent by fats. Whole grains are better than refined flour as a source of carbohydrates. Foods that are rich in iron prevent anaemia, which improves symptoms of heart failure. Studies have shown that exclusive breastfeeding till the age of 6 months protects children against coronary vascular disease.
Healthy diet plan to prevent heart disease in children
Watching television, constant use of computers/laptop and indoor sitting games are all part of sedentary activities which should be limited. Look for ways to promote outdoor field games such as professional sports or outdoor community activities. At school, teachers must help by modifying the behavior and habits of children through regular reinforcement.
It is important to teach children to remain calm in stressful situations. Parents must have realistic expectations of their children. Teaching children coping mechanisms such as talking to parents and friends about problems, taking up a hobby and learning to solve problems independently will give them the confidence to face the challenges of life boldly.
There are two aspects:
1. First is regarding structural heart diseases, which cannot be fully predicted or prevented. Intervention is used to prevent occurrence of this type of heart disease. Treatment includes peri-conceptional maternal micronutrient supplementation, maternal vaccination against viral diseases like rubella, avoidance of consanguineous marriages or fetal echocardiography if there is a prior history of congenital heart disease in the family. Antenatal fetal echocardiography screening can detect a majority of serious and complex heart diseases.
2. The second aspect relates to the occurrence of coronary artery disease in adults, the risk of which starts developing in the adolescent and young adult years. The best way to prevent this type of heart disease is by maintaining a healthy lifestyle that includes a heart-healthy diet and regular exercise regime right from an early age.
Dr Sushil Azad is a Paediatric Cardiologist at Fortis Escorts Heart Institute.
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