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
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)
||less than 170
||less than 110
||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
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 Alfedo, cream sauces, cheese sauces,
- 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.
AHA/AAP Policy Statement. Dietary recommendations for children and adolescents:
a guide for practitioners. Pediatrics. 2006 Feb;117(2):544-559.
Review Date: 10/31/2006
Reviewed By: Alan Greene, M.D., F.A.A.P., Department of Pediatrics, Packard Children's Hospital, Stanford University School of Medicine; Chief Medical Officer, A.D.A.M., Inc.
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