Cardiovascular disease (CVD) proceeds to be the leading cause of death in the United States. Policy and intervention strategies focus on maintaining cardiovascular health in adulthood, but little focus is on childhood cardiovascular health and maintaining healthy behaviors to prevent CVD. While childhood obesity continues to rise above epidemic proportions, little research exists on evaluating, preventing, and detecting cardiovascular disease in children. Even less research is available on prepubescent children, when lifestyles, behaviors and habits are forming. Additionally, comprehensive cardiovascular health status among children is limited due to the complexity of the development of CVD over time. Due to the lack of consistency among screening protocols, few research studies have utilized comprehensive risk assessments. In order to better address the complexity of cardiovascular health in children, a more comprehensive and holistic approach is needed to reduce the risk of CVD and provide primordial care to this age group. Furthermore, innovative approaches in risk assessment are warranted to best individualize risk assessment and improve overall cardiovascular risk profiles. Providing early screening assessments for vulnerable populations, such as children, could provide empirical evidence for the promotion of earlier prevention measures. In addition to probable screening during pediatrician well visits, non-invasive techniques to fully gauge CVD risk should be considered. The use of sonography to quantitatively assess carotid intima media thickness (CIMT) and abdominal adiposity, could be an ideal non-invasive, non-ionizing, portable and relatively inexpensive method to add onto current risk assessment measures. The review of the current literature provided substantial evidence for continued improvement of CVD risk assessment in children. Although the existing literature has substantial gaps, it is evident that risk profiles could be improved through comprehensive evaluations. Substantial target risk factors are evident in adulthood, including BMI, blood pressure, and physical inactivity. These risk factors have also shown to impact childhood health but fails to encompass the relationships between individual risk factors, influences and determinants. Children during adolescence is heavily studied when influences have already become habits. The lack of investigation on middle childhood calls for continued education, research, and strategies to be developed. The most recent national estimates of overweight, obesity, physical inactivity, and elevated blood pressure in children 8-11 years old further supports the need for continued inquiry. Over 35% of children in this age group were considered overweight or obese, over 60% of children failed to meet physical activity recommendations and over 15% had increased systolic blood pressure. Additional differences were noted between males and females, race/ethnicities, and poverty-income ratios. The findings validate the continued CVD risk among children in the United States and multiple of the findings found in this study, are comparable to previous studies that involve older children and adults. The large prevalence of childhood obesity, physical inactivity, and elevated blood pressure further supports a continued modification to preventions strategies for younger children and prioritizing individualized medicine and risk assessments. To identify the relationship of various risk factors with the use of sonographic images of carotid intimal thickness (CIMT) and abdominal adiposity in children 8-11 years old, associations were examined. The use of sonography to measure abdominal adiposity was found to be associated with BMI percentile, limited associations with physical activity, and blood pressure. Further associations were noted between CIMT and blood pressure, abdominal adiposity, and physical activity. The assessment of blood pressure, BMI percentile, and physical inactivity may not be fully apparent in children ages 8-11 years. The findings from this study provide further insight into how additional clinical tools may benefit clinical decision making for risk assessment in children. In order to encompass the whole child maternal child relationships were considered. Associations of sonographic and clinical measures were evaluated between mom and child dyads. Moderate associations of visceral adiposity measures were demonstrated and indicated a possible predisposition a visceral fat accumulation in children. Continued research is needed to further identify maternal influence on CVD risk in children. In the current study no association between maternal BMI and their child blood pressure was noted. This is inconsistent with previous research and maybe do too research design and other social and ecological influences and their impact on childhood cardiovascular health. Ideal cardiovascular health is difficult to conceptualize, however prevention of CVD should be a motivating factor to improve risk assessments and risk stratification. The combination of additional non-invasive CVD risk factor assessments with combined current clinical standards should allow for a better assessment of risk status in children. This will be highly impactful on promoting non-invasive measures to improve the evaluation of disease risk and burden in children. Continued research is crucial to improve clinical decision making and validate risk assessments.