It is important to be aware that children can have high cholesterol. In fact, studies show strong evidence that atherosclerosis (the plaque that builds up in artery walls) actually begins during childhood. This is especially true when one or both parents have a history of high cholesterol or heart disease.
According to the American Academy of Pediatrics (Pediatric Nutrition Handbook 5th Edition, 2004), children and teens should have their blood cholesterol checked if they have a parent or grandparent who had a stroke or heart attack, a positive coronary angiogram, or peripheral vascular disease before age 55.
Any child over age 2 who has a parent with a total cholesterol of 240 mg/dL or more should have a random total cholesterol test. (This means they should have a non-fasting blood test at any time of the day.) If the child's random total cholesterol is over 170 mg/dL, the child should have further blood tests within about 2 weeks. Treatment and the frequency of repeat testing depends on the initial test results, but all children in such situations should have a cholesterol test at least every 5 years.
Cholesterol levels in children
Childhood cholesterol levels were not well-established until fairly recently. Experts now believe that high cholesterol in children may be common. The following chart indicates when cholesterol levels are considered high in children:
|Total Cholesterol (mg/dL)||LDL Cholesterol (mg/dL)|
|Acceptable||less than 170||less than 110|
|High||200 or greater||130 or greater|
It requires more than one measurement to categorize the cholesterol level as borderline or high for a child. If a child has high cholesterol, then the doctor rules out other causes such as thyroid, liver, or kidney diseases. If no underlying cause is found, then, similar to adults, making lifestyle changes is key. This is an important first step, even if other treatments are also necessary.
When children with high cholesterol make lifestyle changes, they reduce their risk of having high cholesterol and heart disease in adulthood.
Diet is key
Until your child is 2 years old, the American Heart Association and the American Academy of Pediatrics recommend that their diet rely primarily on:
- More fruits and vegetables
- More whole-grain foods
- Low-fat and nonfat dairy products
- Beans, fish, and lean meat and poultry
Children under 2 should also eat low amounts of saturated fats, trans-fatty acids, and cholesterol.
To make sure your child has a healthy diet, you should:
- Reduce their added sugar, including sugar-sweetened drinks and juices.
- Reduce their salt intake, including salt from processed foods.
- When cooking, use canola, soybean, corn, or safflower oils, or other unsaturated oils, in place of solid fats.
- Use recommended portion sizes found on food labels.
- Serve fresh, frozen, or canned vegetables and fruits at every meal.
- Limit high-calorie sauces, such as Alfredo, cream sauces, cheese sauces, and hollandaise.
- Serve fish regularly.
- Remove skin from poultry.
- Read bread and cereal labels and make sure that "whole grain" is the first ingredient. Avoid products made with refined flour.
- Serve legumes (beans) and tofu in place of meat occasionally.
- Make sure your child also has at least 60 minutes of moderate-to-vigorous play or exercise each day.
Regular exercise is important for children and helps improve cholesterol levels. Families should try to incorporate exercise into their daily lives. Walking, biking, running, and swimming are just some of the activities that families can do together.
In general, lifestyle changes will be tried for at least 6 - 12 months before medication is considered for children. Your child's blood cholesterol levels will be closely monitored during that time. If their LDL cholesterol level remains high, there is a family history of heart disease, and your child is over 10 years old, medication may be necessary in addition to lifestyle changes.
Glenn Gandelman, MD, MPH, FACC Assistant Clinical Professor of Medicine at New York Medical College; Private Practice specializing in Cardiovascular Disease in Greenwich, CT. Review provided by VeriMed Healthcare Network.
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