Many parents don't give kids' cholesterol levels a second thought. But since high cholesterol can run in families, it’s understandable that you might be concerned about your children's heart health if you yourself have unhealthy levels of total or LDL ("bad") cholesterol (in adults, that's 240 mg/dL or higher total cholesterol or 160 mg/dL or higher LDL cholesterol).
Medical conditions that run in families, inherited traits, and shared lifestyle factors can contribute to high cholesterol in children. For example, some people have inherited genes from their parents that cause the body to make too much LDL (a condition called familial hypercholesterolemia), and it’s possible for kids to inherit those same genetic traits.
Having a family history of high cholesterol or cardiovascular disease doesn't necessarily mean that children will experience harmful effects, but parents should be aware of the increased risk of future complications, such as heart disease.
High Cholesterol Affects One in Five Kids
Your parental concern about your child's cholesterol levels certainly is not out of place for other reasons, too. Doctors used to worry less about children's and teenagers’ cholesterol, because harmful effects of atherosclerosis (plaque build-up in the arteries) were only seen after decades of elevated levels. But in recent years, as childhood obesity, unhealthy diets and sedentary lifestyles have become more common, more children and adolescents have been diagnosed with high cholesterol. In 2010, the Centers for Disease Control reported that at least 20% of children ages 12 to 19 have at least one measure of elevated lipids.
According to guidelines from the National Cholesterol Education Program, both men and women should have their cholesterol tested every five years starting at age 20. But people with risk factors for high cholesterol and heart disease should be tested earlier and more often—even kids.
Family History Means Early Cholesterol Screening
In 2008, the American Academy of Pediatrics issued guidelines for cholesterol screening in children. If your child has at least one parent with high cholesterol, he or she should be tested as early as age 2 and before age 10. This can be done with a simple fasting blood test at the doctors’ office.
Your child should also be tested if one of the following applies:
- At least one parent was diagnosed with premature heart disease (i.e., onset before age 56 for men or age 66 for women).
- Your child's family history is unknown (due to adoption, for example).
- Your child is overweight.
A child or adolescent who has risk factors such as high blood pressure, diabetes, or a smoking habit also should have early testing.
Kids who are shown to have normal levels after testing should be retested again in three to five years. Those who are found to have high LDL levels—over 130 mg/dL—should receive lifestyle counseling aimed at optimizing diet and physical activity to reduce LDL cholesterol.
Cholesterol Medication for Kids
Medications are not necessarily always started young, but kids can be considered for drug therapy starting at age 8 in the following cases:
LDL cholesterol is
- 190 mg/dL or higher
- 160 mg/dL or higher and the child has a family history of early heart disease or two or more risk factors (such as obesity, high blood pressure and/or smoking)
- 130 mg/dL or higher and the child has diabetes (type 1 or type 2)
Once medications are started, the dose is titrated to reach a goal of 110 to 160 mg/dL LDL cholesterol, depending on the family and the child's medical history.
That said, the idea of putting 8-year-olds on cholesterol medication has been a controversial one in the medical community. Statins and other medications used to treat high cholesterol have not been studied in children long-term, but proponents argue that the risks of not treating childhood high cholesterol are too great.
If your child's cholesterol is high enough to meet the recommendations for medication, your doctor can help you decide whether to put him or her on medication. Your pediatrician may refer you to a specialist who can make recommendations based on your child's specific case.
Reduce Kids’ Risk with Diet and Exercise
Before you try medication, there are other things you can do to lower your children's cholesterol or to help keep it at a healthy level. Dietary modifications and exercise to help your kids maintain a healthy weight should be your first plan of attack.
All children age 2 and older should consume reduced-fat milk—but if you have a family history of obesity, high cholesterol, or heart disease, or if your doctor is worried about future weight problems, you may be advised to switch from whole to reduced-fat milk (and eliminate other forms of saturated fats from your child’s diet) as early as 12 months.
Older children with high cholesterol should be put on a diet that restricts saturated and trans fats (such as from fatty meats, cheeses and butter), and contains no more than 200 mg of cholesterol per day.
The best way to fight high cholesterol is the same for kids as it is for adults: The American Heart Association recommends (for all ages):
- exercising for at least 30 to 60 minutes most days of the week
- eating more fruits, vegetables, fish, whole grains, and low-fat dairy products
- limiting salt, fruit juice, and sugary foods and drinks
Encourage these habits by setting a good example yourself and incorporating healthy foods and activities into your family routine.
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American Heart Association. Cholesterol and Atherosclerosis in Children. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4499. Accessed: May 18, 2011.
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Centers for Disease Control and Prevention. "Prevalence of abnormal lipid levels and eligibility for therapeutic lifestyle counseling among youth—United States 1999–2006." MMWR—Morbidity and Mortality Weekly Report. 2010;59:29-33.
Daniels, Stephen R.; Greer, Frank R.; and the Committee on Nutrition. “Lipid Screening and Cardiovascular Health in Childhood.” Pediatrics. 2008; 122:198-208.
National Cholesterol Education Program. "Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)." Available at: http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3xsum.pdf. Accessed: May 18, 2011.
National Human Genome Research Institute. Learning About Familial Hypercholesterolemia. Available at: http://www.genome.gov/25520184. Accessed: June 17, 2011.
Ritchie, et al. "Universal Versus Targeted Blood Cholesterol Screening Among Youth: The CARDIAC Project." Pediatrics 2010; peds:2009-2546