| Family history of early CVD | — | At 3 years, evaluate family history for early CVD: parents, grandparents, aunts/uncles, men ≤ 55 years, women ≤ 65 years; review with parents and refer as needed; positive family history identifies children for intensive CVD risk factor attention | Update at each nonurgent health encounter | Reevaluate family history for early CVD in parents, grandparents, aunts/uncles, men ≤ 55 years, women ≤ 65 years | Update at each nonurgent health encounter | Repeat family history 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 | Obtain smoke exposure history from child; 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 12 months of age if possible; add formula if breastfeeding decreases or stops before 12 months of age | At age 12 to 24 months, may change to cow's milk with 2% fat decided by family and children's health care professional; after 2 years of age, fat-free milk for all; juice ≤ 4 oz per day; transition to CHILD-1* by 2 years of age | Reinforce CHILD-1* messages | Reinforce CHILD-1* messages as needed | Obtain diet information from child and use to reinforce healthy diet and limitations; provide counseling as needed | Review healthy diet with patient |
| Growth, overweight/obesity | Review family history for obesity; discuss weight-for-height tracking, growth chart, and healthy diet | Chart height/weight/BMI; classify weight by BMI from age 2 years; review with parent | Chart height/weight/BMI and review with parent; BMI ≥ 85th percentile, crossing percentiles: intensify diet/activity focus for 6 months; if no change, registered dietitian referral, manage per obesity algorithms; BMI ≥ 95th percentile: manage per obesity algorithms | Chart height/weight/BMI and review with parent and child; BMI ≥ 85th percentile, crossing percentiles: intensify diet/activity focus for 6 months; if no change, registered dietitian referral, manage per obesity algorithms; BMI ≥ 95th percentile: manage per obesity algorithms | Chart height/weight/BMI and review with child and parent; BMI ≥ 85th percentile, crossing percentiles: intensify diet/activity focus for 6 months; if no change, registered dietitian referral, manage per obesity algorithms; BMI ≥ 95th percentile: manage per obesity algorithms | Review height/weight/BMI and norms for health with patient; BMI ≥ 85th percentile, crossing percentiles: intensify diet/activity focus for 6 months; if no change, registered dietitian referral, manage per obesity algorithms; BMI ≥ 95th percentile: manage per obesity algorithms |
| Lipids | No routine lipid screening | Obtain fasting lipid profile only if family history for CVD is positive, parent has dyslipidemia, child has any other risk factors or high-risk condition | Obtain fasting lipid profile only if family history for CVD is positive, parent has dyslipidemia, child has any other risk factors or high-risk condition | Obtain universal lipid screen with nonfasting non-HDL cholesterol (total cholesterol minus HDL cholesterol), or fasting lipid profile; manage per lipid algorithms as needed | Obtain fasting lipid profile if family history newly positive, parent has dyslipidemia, child has any other risk factors or high-risk condition; manage per lipid algorithms as needed | Measure one nonfasting non-HDL cholesterol or fasting lipid profile in all: review with patient; manage with lipid algorithms per Adult Treatment Panel guidelines as needed |
| Blood pressure | Measure blood pressure in infants with renal/urologic/cardiac diagnosis or history of neonatal intensive care unit | Check blood pressure annually in all from the age of 3 years; chart for age/sex/height percentile and review with parent | Check blood pressure annually and chart for age/sex/height: review with parent; workup or management per blood pressure algorithm as needed | Check blood pressure annually and chart for age/sex/height: review with parent; workup or management per blood pressure algorithm as needed | Check blood pressure annually and chart for age/sex/height: review with parent; workup and/or management per blood pressure algorithm as needed | Check blood pressure: review with patient; evaluate and treat per Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines |
| Physical activity | Encourage parents to model routine activity; no screen time before the age of 2 years | Encourage active play; limit sedentary/screen time to ≤ 2 hours per day; no television in bedroom | Recommend moderate-to-vigorous physical activity of ≥ 1 hour per day; limit screen/sedentary time to ≤ 2 hours per day | Obtain activity history from child: recommend moderate-to-vigorous physical activity of ≥ 1 hour per day and leisure screen time of ≤ 2 hours per day | Use activity history with adolescent to reinforce moderate-to-vigorous physical activity of ≥ 1 hour per day and leisure screen time of ≤ 2 hours per day | Discuss lifelong activity, sedentary time limits with patient |
| Diabetes mellitus | — | — | — | Measure fasting glucose level per American Diabetes Association guidelines; refer to endocrinologist as needed | Measure fasting glucose level per American Diabetes Association guidelines; refer to endocrinologist as needed | Measure fasting glucose level if indicated; refer to endocrinologist as needed |
