The role of the pediatrician in the prevention of coronary heart disease in childhood.

Recent epidemiologic and clinical studies have led to a much better definition of coronary heart disease risk factors and to the conclusion that an effective primary prevention program should begin in the pediatric age group. What remains unanswered is who should start the process in the pediatric age group and how? In view of the high degree of pediatric involvement in prevention and the family contacts, pediatricians are high on the list of suitable candidates for implementing coronary heart disease preventive measures in children. It nevertheless remains unclear as to how much counseling must be done by pediatricians and at what intensity, so as to avoid undue harm. There is, therefore, a clear-cut need for guidelines to the general pediatrician for a sensible, effective and specific, yet harmless and cost efficient, approach. Since eating habits in infancy establish the basis for lifetime eating habits, pediatricians can have a significant impact by encouraging a diet low in sodium, saturated fat and cholesterol, while adequate in calories and thoroughly meeting the nutritional needs of a growing child. Counseling regarding dietary moderation, avoidance of obesity and smoking, and regular exercise can and should become part of a pediatrician's counseling aimed at the prevention of coronary heart disease.