Ideal diet and physical activity have an alarmingly low prevalence among CVH metrics in this age group Criteria for ideal CVH in children are variable and associated with differences in prevalence of ideal for certain metrics Our review highlights importance of modifying criteria for a younger population, specifically for diet and physical activity There is an opportunity for future studies to determine the appropriate age to begin monitoring all seven metrics Providers should work to shift the emphasis towards primordial prevention due to benefits on adult CVH and outcomes