Parents play an important role in helping children adopt a healthy lifestyle

Ineke Bosch is a physician assistant at the Children’s Clinic at Flevo Hospital in Almere. She is deeply committed to caring for children with conditions such as hereditary high cholesterol. Her clinic within the Children’s Clinic is the LEEFH Center.

“Our LEEFH center originated from the diabetes clinic, where high cholesterol is also a risk factor,” she explains. “I started working alongside a vascular specialist and eventually ended up with Bert Wiegman, who was then a pediatric cardiologist at the AMC and had extensive expertise in FH in children. This really opened my eyes. One in 300 people—and therefore one in 300 children—has FH. That is a major risk factor for cardiovascular disease, both in childhood and certainly once children reach adulthood. It is very important to detect this, especially since it is so treatable. Together with Bert Wiegman, we then established the pediatric clinic for FH at De Kinderkliniek.”

Brushing your teeth

The doctor doesn’t force this on people, but discusses it with them. “Sometimes people suggest that they first try to lower their cholesterol by making lifestyle changes. I always think that’s a great idea. Then we see what the outcome is. Medication often ends up being necessary anyway, but at least they’re on board with it, and we’ve tried everything before starting. People will be taking medication for the rest of their lives, so it’s important that they’re motivated to do so.”

Collaboration

Children end up seeing Ineke for various reasons; either because one of their parents has FH, or because a child with high cholesterol is referred from another clinic at De Kinderkliniek, and it subsequently turns out that they have FH. “It happens that a new FH family is identified through the child. For example, we have already identified several children with elevated Lp(a) (congenital elevated Lp(a) increases the risk of cardiovascular disease, ed.). Nowadays, children with elevated LDL are increasingly being referred to us by general practitioners and from other clinics at De Kinderkliniek. That’s a very positive development,” says Ineke. “Because there are effective treatment options, it’s very important to know what’s going on. For a child with hereditary high cholesterol, treatment can be started as early as age eight if necessary. This isn’t just better for their health, but it also helps the child learn to manage it at a young age. By eating healthy, not smoking, and exercising, but also by taking their medication every day. That it’s just part of life, just like brushing your teeth. I always explain to children that toothpaste is for cleaning your mouth and pills are for keeping your blood vessels clean.”

Guilt

In addition to working with children, Ineke also supports parents. “They play a key role in helping their child adopt a healthy lifestyle. Sometimes I have to rein them in. Exceptions are allowed; otherwise, it’s impossible for a child. It’s perfectly fine to have fries on the menu once in a while, but not every day.” Parents are sometimes shocked to learn that their child has a condition that is congenital and will never go away. Ineke: “Sometimes they feel guilty, so we talk about that. Because, of course, there’s absolutely nothing they can do about it. We help parents support their child as best as possible. And then I hope that something that poses a risk will become a kind of normal. Something you can live with very well. And with which a child can lead a long and happy life.”