Kids and Healthy Hearts



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Children who don’t have heart problems as kids may develop them as adults, due to risk factors like obesity and hereditary factors, says Dr. Linda E. Muhonen, a pediatric cardiologist at CHOC Children’s. Risk factors that contribute to coronary artery disease and other cardiovascular diseases include smoking, poor diet that can lead to  dyslipidemias, high blood pressure and a lack of exercise. These often take root at an early age. “An obese child has an 80 percent chance of being an obese adult, and obesity can contribute to the onset of multiple illnesses including diabetes and hypertension,” says Dr. Muhonen.

“Parents should avoid bringing unhealthy foods into the home, such as soda or sugar-sweetened drinks,” says Dr. Muhonen. “The only drinks most kids should have are water and fat-free milk. Kids should eat three meals a day with snacks of fruits and vegetables in between. Many children skip meals, creating an environment of overeating at  the next meal; skipping meals can lead to lowering your metabolic rate. We encourage children to bring their lunch to school so they can pack something healthy like a turkey sandwich on whole wheat bread, a piece of fruit and some pretzels or string cheese.”

“I like to see families have some healthy family time before dinner, like going for a family walk or going to the park before they sit down to eat,” says Dr. Muhonen. “This gets the kids to move. One of the rules in our Lipid Clinic, where we help kids at risk for developing heart disease, is that children cannot watch TV or have screen time until they have been outside for an hour doing a physical activity. The American Heart Association recommends that children have an hour a day of moderate to vigorous physical activity. It doesn’t have to be all at one time,” she says.

Children are considered overweight if their Body Mass Index (BMI) falls in the 85-94th percentile. They are considered obese if their BMI falls in the 95th percentile or above, says Dr. Muhonen. Parents can ask their  pediatrician to help make this determination.


  • Approximate number of children ages 12-17 who are already smokers: 4.5 Million
  • Percentage of obese children who will become obese adults: 80%
  • Approximate percentage of children and adolescents (ages 6-19) who were overweight or obese in 2010: 33%

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Dr. Linda Muhonen


Dr. Muhonen helps patients with the full spectrum of heart conditions, with special emphasis in preventive cardiology. She also directs the Children’s Cholesterol (Lipid) Clinic at CHOC. Dr. Muhonen served her Pediatric Cardiology fellowship at the University of Iowa Hospital in Iowa City and she completed her internship and residency at Loma Linda University Medical Center. Part of her practice focuses on helping children avoid heart problems related to genetics and/or obesity later in life. She is the leading physician at CHOC’s Lipid Clinic, which treats these “at risk” children.

Dr. Muhonen’s philosophy of care: “I focus on the family as a whole when treating children with heart and obesity related problems. You can’t just focus on the child because a child is a product of genetics and their environment.”

Oral Roberts School of Medicine – Tulsa, Oklahoma

Pediatric Cardiology

More about Dr. Muhonen | More about The Heart Institute at CHOC Children’s

This article was featured in the Orange County Register on February 17, 2014 and was written by Amy Bentley.

A Healthy Heart Starts Early

Did you know the seeds for a healthy heart in adulthood are often planted during childhood? Children with poor diets and inadequate exercise can develop a range of heart-related diseases later in life.

Parents and other caregivers can set children on a path to a healthy heart, says Dr. Linda Muhonen, a pediatric cardiologist at CHOC Ch20130426_0625ildren’s who also leads CHOC’s Lipid Clinic. (“Lipid” is a general term for molecules in the body that include fat.) Often, this means a permanent lifestyle change for families.

“For kids to have a healthy heart during their lives, families have to lead more healthy lifestyles from the start,” Dr. Muhonen says. Parents should model heart-healthy habits to their children. Prevention is the best way to avoid heart problems later in life.”

Dr. Muhonen and the Lipid Clinic staff help children with genetic dyslipidemias or who are overweight or obese lower their risk for developing heart disease and related illnesses such as asthma or diabetes. They study the patient’s history, examine the child, prescribe medication if necessary and set up new dietary and exercise goals for kids and families with the help of a dietitian and exercise physiologist , she says.

“The bottom line is that our kids are developing diabetes in early adolescence,” Dr. Muhonen says. “Kids can also develop asthma, hypertension and fat in the liver, which can lead to chronic liver disease all related to obesity. You can help prevent these illnesses by not having a sedentary lifestyle and not becoming obese.”

Dr. Muhonen offers some dietary and exercise tips for parents to establish heart-healthy habits for their children:

  • Avoid soda, juice and other sugar-sweetened drinks; offer the kids fat-free milk at meals and water the rest of the day. “You should avoid drinking your calories,” Dr. Muhonen says.
  •  Children should eat three meals a day with snacks of fruits and vegetables in between.
  • Don’t let the children skip meals. Skipping meals can lead them to overeat at the next meal and can slow down your metabolism.
  • Have kids take their lunch to school instead of buying lunch. Pack a heart-healthy lunch such as a tuna or turkey sandwich on whole wheat bread with a piece of fruit and some pretzels or string cheese, and a bottle of water.
  • Never reward children with food. Encourage kids to get an hour of physical activity each day. This can be whatever activity or sport interests the child. “You don’t need a gym membership or equipment to get some exercise,” she says.
  • Warn children about the dangers of cigarette smoking and encourage them never to start

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