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Risk Evaluation to Achieve Cardiovascular Health (REACH) Clinic

We've all been told the importance of a healthy lifestyle in adulthood to help prevent heart attacks and type 2 diabetes. But did you know that the risk begins way before we become "grownups?" This is especially true for children who have a family history of cardiovascular disease, diabetes and other risk factors that can contribute to heart disease later in life.

Here at the Cook Children's Risk Evaluation to Achieve Cardiovascular Health (REACH) clinic, we're dedicated to providing excellent, patient-centered care, as well as access to the most up-to-date therapies and clinical research. Our REACH team is committed to improving the lives and well-being of children who are at risk or affected by obesity, high blood pressure or high blood fats. We do this through a complete medical history, as well as changes in lifestyle, education and, when necessary, medication.

Doctor and patient at Cook Children's REACH programCardiovascular disease is the leading cause of death in the U.S. And while it is rare for children or teens to have a heart attack, many of the preventable cardiovascular problems that develop in adulthood begin in childhood. Fortunately, reducing the risk of heart attack can also begin very early in life.

What we do

The REACH program at Cook Children's Medical Center works with children and their families to prevent premature heart disease and diabetes. Treatments include changes in lifestyle and, when necessary, medications. First, each child undergoes a complete checkup, looking for medical reasons that can cause weight gain, high blood pressure, high blood fats, and other problems that may result in premature heart disease as children grow into adulthood. When appropriate, other tests may be preformed, such as checking your child's fitness level, ability to exercise and need for a special diet. Families are offered education and coaching to help make the changes necessary to improve your child's health.

Educational program

Depending on your child's diagnosis, our team may recommend that you, your child and family members will take one or more classes between each follow-up visit. Each class is one hour in length. Classes offered include:

  • Healthy living kick start
    Learn all about healthy eating, reading nutrition labels, physical activity and more!
  • Sorting the starches
    Find out how to choose drinks, desserts and healthy carbohydrates.
  • Facing the fats
    Discover kid-friendly cooking tips and heart-healthy fats. While this class is helpful to all, it is strongly recommended for children with familial hypercholesterolemia.
  • Figuring out fiber
    Explore tasty whole grains, vegetables and fruit

Common conditions we see

Health risks that may result in heart attacks or type 2 diabetes in the future, may be caused by many conditions, among them:

Here at the Cook Children's REACH clinic, the main conditions we see are:

There is strong evidence linking diabetes, high blood pressure and elevated blood levels of "bad fats" (e.g. total and LDL-cholesterol) to early heart disease. When present in children, the damage to blood vessels from cardiovascular risk factors are often made worst by excessive weight gain, a low level of physical activity and poor diet.

New patient forms

To help make your first visit to our office a little easier, please print and fill out the new patient form below and bring it with you to your appointment. We've also provided a checklist that will help you prepare for your visit and save time and stress.

Preparing for your first visit

Before your child's first visit to our clinic, we will discuss with you required medical testing and information that we will need. This will include:

  • Obtaining a referral from your child's primary care doctor.
  • Filling out a detailed questionnaire outlining your child's medical history.
  • You may be asked to schedule lab tests to check your child's cholesterol and tests for diabetes.

The REACH team may also recommend other tests as part of a comprehensive diagnostic evaluation. The panel includes:

  • Body measurements, such as height, weight and blood pressure.
  • Bioelectrical impedance to tell us how much of your child's body is composed of muscle and fat.
  • Fitness tests, like the Modified Harvard Step Test.
  • Blood tests, including thyroid function, lipid panel, liver function tests and test for diabetes.

What to expect at your first visit

We look forward to helping you and your child achieve and maintain a heart healthy lifestyle. To help make sure your visit to our clinic goes smoothly and your child gets the most benefit from each visit, here are some suggestions:

  • Please be sure the appointment you received is convenient for you and your child. If the appointment you receive is not convenient, please let our staff know when it would be best for your child to be seen. Our staff will make every attempt to meet your needs within our regular clinic hours.
  • To allow our staff to become familiar with your child and complete a thorough evaluation, please plan to be present in our clinic for at least 2 hours.
  • The presence of younger siblings may limit your ability to pay attention. Many parents / guardians find it best to make arrangements ahead of time for child care.
  • Inform your employer/your child's &school of the date/time you will be absent for this appointment.
  • Write down questions/concerns. We will be happy to address them during your visit.
  • Please bring your child's completed questionnaire to your initial visit. If you have any questions about the information being requested, you can ask for assistance in completing those questions at the time of the visit.
  • We are happy to provide you and your child a work/school excuse. If needed, please request one from our front desk staff at the end of the visit.

For the initial visit, your child will not need to fast (that is, has had nothing to eat or drink). Please have him/her eat as usual and take any medications that have been prescribed by your child's doctor.

Appointment checklist

  • Mark the date/time of your child's REACH Clinic appointment on your calendar.
  • Confirm the location of the Clinic. Directions are available here.
  • Complete the questionnaire and bring it, along with any medical information (including previous lab tests) about your child, to his/her initial visit.
  • Notify your employer and your child's school of the date/time of your clinic visit.
  • Have you child eat his/her usual breakfast.
  • Plan to arrive 15 minutes before your child's appointment to allow our staff sufficient time to process the paper work for your child's visit.

During your appointment

During your first clinic visit, a member of our REACH staff will:

  • Measure your child's height, weight, blood pressure, waist, hips, body mass index (BMI).
  • Ask for a detailed history of your child's health.
  • Ask for a detailed history of your family's health, especially if there is any high blood pressure, heart disease, high cholesterol or diabetes.

Your child will also see a specially trained physician who will:

  • Perform a complete physical exam.
  • Review what other doctors have said about your child's health.
  • Find out what other medical problems your child may have.

Once your visit is complete, our team may recommend a more comprehensive diagnostic evaluation for your child. This allows the team to create a program that is custom-fit to the needs of your child, thus helping him or her to reach their health goals.

Testing and diagnosis

To better understand each child's current health and future risk of cardiovascular disease and diabetes, our REACH team may recommend a comprehensive diagnostic evaluation if your child's diagnostic evaluation has not been completed by your primary care physician before your first REACH clinic appointment. If not, it will be scheduled on a separate day after your child has fasted (that is, has had nothing to eat or drink) for at least 9 hours.

A panel of tests is obtained during the diagnostic evaluation to help show your child's risk for heart problems, often referred to as cardiovascular risk factors. As the parent or caregiver, we consider you an important part of our team. So, if you don't understand the purpose of a test, what your child can expect, or any of the test results, we encourage you to ask your child's primary care doctor or our REACH team to explain. Tests that are often recommended are:

  • Body measurements: measurement of your child's height, weight, waist, hips and blood pressure.
  • Bioelectrical impedance: This test tells us about how much of your child's body is muscle, and how much is fat.
  • Fitness test: Fitness is an important part of staying healthy. The child will be asked to step up and down for about 3-5 minutes. This is called the Modified Harvard Step Test.
  • Blood tests: A small sample of blood will be taken from your child's arm. For the test to be most accurate, your child should not eat or drink anything for 9 hours before this test. A panel of tests help the REACH team evaluate each child's health and future risk, including:
    • Thyroid function
    • Insulin resistance / diabetes
    • Lipid panel
    • Liver function tests

Psychosocial profile

Because many children who have health problems or concerns may have poor self-esteem, depression, and/or feelings of fatigue, all children undergo a screening test to determine if one or more of these problems are present.

Many of the problems associated with being overweight/obese, having high blood pressure or high blood fats are improved by a heart healthy lifestyle and maybe medicine. To be successful, children and their families should be willing to take the time and effort to make changes in lifestyle that will help your child and your entire family. This is measured by:

  • Peds Quality of Life Assessment
  • Readiness to Change Questionnaire
  • Other questionnaires are sometimes helpful and are administered on an as-needed basis

Following your child's diagnostic evaluation, our REACH team will contact you, your child and family to discuss the results and create a plan that fits your child's and your family's needs.At this time, we will also work with you to schedule your follow-up clinic visits.

Follow-up clinic visits

Based on your child's specific needs, your child's follow-up visits will be scheduled every 3-6 months.

New patients are generally seen in our REACH Clinic on Mondays. Follow-up appointments, if needed, are scheduled on Tuesdays and Thursdays.

During your child's follow-up appointment, we will:

  • Review your child's diagnostic evaluation, including history, measurements, fitness testing, and test results.
  • Discuss what medical problems were found.
  • Discuss what your child's risk is for high blood pressure, heart disease, stroke, or diabetes.
  • List the treatment choices, reviewing the benefits and risks of each.
  • Recommend some lifestyle changes the family can start now.
  • Provide your family with a summary of what was found and what treatments were recommended.

Learning to eat properly is a very important part of the REACH program at Cook Children's. For that reason, our dietitians plays a key role in your child's treatment plan.

What and how we eat is very personal, and even when we know other choices may be healthier, it is hard to change what we are used to.

REACH healthy eating planningHealthy eating is important. We work with the family and the patient to create a plan everyone will love.

With specialized training in the dietary needs of children, our dietitian will provide a detailed plan for improving your child's diet and will encourage him or her to be more active. Our team understands that what and how kids and families eat is very personal, and sometimes filled with tradition.

Even when we know other choices may be healthier, it can be hard to change what we are used to. For that reason, as part of our program, the REACH Team is committed to continuing to support each family in making necessary changes through education and counseling.

Based upon the needs of your child and family, follow-up REACH clinic visits are scheduled about every 3 to 6 months. During clinic visits we will:

  • Measure your child's growth, weight, blood pressure and selected blood tests, comparing the results to our past measurements.
  • Review what your child and family are eating, and how it is working.
  • Discuss your child's level of physical activity and time spent less active.
  • Checking your child's health and medicines, and making changes if necessary.
  • Talking about what the family can do to maintain a healthy lifestyle, now and in the future.
  • Providing encouragement and support.

Our REACH specialty care team

Our REACH team is committed to improving the lives and well-being of children who are at risk or affected by high blood fats or pre-diabetes. Your child will have the support of our specially trained doctors, nurses, dietitians, clinical therapist and social services specialist. Together, we look forward to helping every child reach the goal of being heart healthy ... both in childhood and well into the future!

Kim CoxKim Cox
Clinical Therapist
Lisa GuerraLisa Guerra
RN
Luke HamiltonLuke Hamilton
Research Project Manager
Melody JohnsonMelody Johnson
Administration
Ryan MurphyRyan Murphy
Social Services
Brenda SonnierBrenda Sonnier
Child Life Specialist
Ana TovarAna Tovar
Spanish Translator
Amelia VinsonAmelia Vinson
RN, REACH Coordinator
Lauren WilliamsLauren Williams
RD
Kim CoxKim Cox
Clinical Therapist

Resources & education

Here you'll find fun, helpful resources and educational information for the whole family. And lots of useful tools to help you on your journey to a heart healthy life:

For health professionals and referring clinicians

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States, and the antecedents of CVD emerge early in life. While many of these children with increased risk have a genetic cause, such as familial hypercholesterolemia, increasingly unhealthy lifestyle behaviors play a significant role as well.

CVD risk factors in youth, like in adults, are exacerbated by dyslipidemia, insulin resistance, prehypertension / hypertension and unhealthy lifestyle behaviors such as low physical activity and poor diet. Moreover, CVD risk factors in childhood persist into adulthood and predict cardiovascular outcomes decades later. Unless children with genetic CVD risk factors are found early and appropriate intervention and prevention efforts are implemented, coupled with the current epidemic of obesity among children and adolescents, these children are at substantial risk of premature heart attack and stroke during adulthood.

To help address these emerging trends, the Endocrinology Program at Cook Children's developed the REACH (Risk Evaluation to Assure Cardiovascular Health) Clinic . The clinic was established to better understand the cause(s) of premature cardiovascular diseases, including genetic and acquired forms of dyslipidemia, insulin resistance and "prediabetes", childhood obesity and weight related health risks; developing effective means of prevention through health education, early detection of those at risk and timely treatment.

Screening and referral guidelines

The REACH clinic is committed to:

  • Providing family centered care, education and follow up.
  • Promoting sustainable heart-healthy behaviors through health education and lifestyle modification.
  • Comprehensive evaluation and, where beneficial, offering new and emerging therapies.
  • Providing appropriate genetic counseling for families.
  • Participating in research activities to develop better diagnostic and therapeutic interventions.
  • Supporting community based initiatives in partnership with Primary Care Providers.
  • Mentoring other health care professionals, student learners, residents and fellows; offering preceptor programs and giving invited presentations on cardiovascular risk assessment, prevention and treatment.

The Division of Endocrinology also collaborates with a variety of leading regional and national clinicians and scientists to improve the health and well-being of children and adolescents by finding better diagnostic tests, effective measures of prevention and treatments for children at risk for premature cardiovascular disease.

Who can benefit from the REACH clinic?

Children and adolescents who:

  • Have acquired or genetic dyslipidemia (e.g. high cholesterol, high triglycerides, low HDL-c).
  • Are known or suspected of having insulin resistance, "prediabetes" or type 2 diabetes mellitus.
  • Are known or suspected of having metabolic syndrome.
  • Have acquired and genetic forms of hypothalamic obesity.

Case studies

Consultations and referrals

Please contact:

Cook Children's Endocrinology
REACH Clinic
1500 Cooper St., Second floor
Fort Worth, Texas 76104-2724
Phone: 682-885-7960

View this animation to learn about high cholesterol

Cook Children's presents an animated video about the risk of high cholesterol (hyperlipidemia) and high triglycerides in the body.

Preventing cardiovascular disease caused by genetic forms of hypercholesterolemia

Dr. Perry and Dr. Keator review data

Preventing cardiovascular disease caused by genetic forms of hypercholesterolemia

Don Wilson, Cook Children's endowed chair, medical director, REACH (Risk Evaluation to Achieve Cardiovascular Health) program talks about the genetic forms of hypercholesterolemia and screening guidelines. He shares how mandatory screening can not only prevent cardiovascular disease in children, but also their parents and other family members.

Click here to download

We're here to help.

If your child has been diagnosed, you probably have lots of questions. We can help. If you would like to schedule an appointment, refer a patient or speak to our staff, please call our offices at 682-885-7960.