FAQs

Cholesterol is a waxy material that can be made by your body or come from foods you eat. It does some important things in your body. It is used to make some hormones and to build your cell walls. Unfortunately, having the wrong balance of cholesterol can lead to health problems such as coronary artery disease (the blockage of arteries carrying blood to your heart) and strokes.

In 2011, new guidelines recommended “Universal Screening”, meaning that ALL children, at certain ages, have their cholesterol tested. Guidelines have previously recommended checking cholesterol levels in children with certain risk factors. Unfortunately that selective screening was not as effective, missing 30-60% of children with significant cholesterol problems. The change to checking ALL children surprised many. Part of the reason for the broader testing is to identify a disease called Familial Hypercholesterolemia (FH). It occurs in 1 in 250-300 people in America and, in its most severe form, can lead children to start developing blockages in their arteries during childhood and adolescent years. Most people with FH can be diagnosed by a cholesterol blood test along with a family history of premature heart disease. In a family that is unaware that they have FH, the first signs can be when a family member has a heart attack. Many people with FH have a normal body weight. Since you can’t feel high cholesterol, many people with FH are first diagnosed when they get the routine blood test. Universal screening of children helps identify those children so that they can learn about healthy choices and treatment options before their arteries start to show signs of plaque (blockages). To learn more about FH, visit the FH Foundation: theFHFoundation.org The newest American Heart Association/American College of Cardiology 2018 Guidelines for Cholesterol also recommend screening children for cholesterol problems: Guideline on the Management of Blood Cholesterol The American Heart Association also published a Scientific Statement in 2019 Regarding Cardiovascular prevention in children: Cardiovascular Risk Reduction in High-Risk Pediatric Patients

If children already carry a “risk factor” for developing heart disease in the future, then they should have their cholesterol tested before age 9. If they have no other risks, then it is reasonable to wait until between the ages of 9 and 11 to test a child’s cholesterol. These same guidelines also recommend rechecking a child’s cholesterol between the ages of 17 and 21. These recommendations were updated and supported in the 2018 AHA/ACCGuideline on the Management of Blood Cholesterol and the AHA 2019 Scientific Statement Cardiovascular Risk Reduction in High-Risk Pediatric Patients. The ages when screening of kids cholesterol is done are crucial times in a child’s growth and maturity. Between 9 and 11 many children are experiencing the onset of puberty. They are also becoming “pre-teens” who are starting to make their own decisions…and develop their own habits. This is a great time to discuss your family’s wellness strategy with your primary care provider. How are you doing? Are there choices your child is making that worry you? Are you a good role model of wellness for your child? No one is perfect, so don’t worry. Take this opportunity to take a snapshot of your family’s wellness and then set goals for the next year or more. The next age group for routine screening is between the ages of 17 and 21. At this stage, your child is progressing into young adulthood. They have new responsibilities, new pressures, and new priorities. How can you and your child’s primary care provider work together to ease this transition and support them in making healthy choices?

Normal, borderline, and high cholesterol results in children: For children with no known risk for high cholesterol or heart disease, it is ok to have the test performed without fasting. If a child has any suspected risk for high cholesterol or heart disease, then your healthcare provider may prefer a fasting test. Fasting usually mean eating no food and drinking no beverages other than water for 12 hours. Please ask your healthcare provider for their recommendations so that your child can have the most accurate test completed.

First, you should always speak with the healthcare provider who ordered the test for advice. They know your child’s health conditions and will be able to start the conversation about possible reasons for the result. In most children, changes in food and exercise choices are the first steps. A CHILD-1 eating pattern is recommended for any child with high cholesterol or other heart disease risks by the current guidelines. In addition to nutrition, physical activity is an important part of getting and keeping cholesterol at health levels.

If your child has high cholesterol, then the guidelines recommend a “CHILD-1” eating pattern to start out. It includes: Less than 30% of calories should come from fat, with <7% coming from saturated fat sources The remainder of fat in the diet should come from mono-unsaturated and poly-unsaturated fat sources ​Avoid trans fats ​50-55% of calories should come from carbohydrates ​15-20% of calories should come from protein ​Intake of dietary cholesterol should total 300mg or less per day Avoid sodium and avoid foods high in salt ​Eat fruits and vegetables Increase fiber intake (the grams of fiber today should equal the child’s age in years + five grams, up to 14 grams/day) ​Consider supplementing vitamin D Fat free milk only after age 2.​​ Avoid sugar-sweetened beverages (limit juice to 4 ounces per day of 100% fruit juice only) Encourage water intake A tip on calculating these amounts: Ask your healthcare provider for the total recommended calories your child should get per day. This will depend on how active your child is, as well as their age and current health status. Calculating the appropriate amounts of nutrients can feel like a challenge. Many families choose to seek a registered dietitian’s help. If the Child-1 eating pattern is not successful, the guidelines recommend a CHILD-2 eating pattern, which is dependent on which portion of the cholesterol is still high. A registered dietitian is highly recommended in the guidelines if your child’s cholesterol does not improve after trying Child-1.

Exercise can help improve cholesterol. Your muscles use triglycerides for energy, so exercise is very helpful for some triglyceride problems. It also can help raise HDL (the “good” cholesterol). Most importantly, exercise helps improve your overall heart and body health. Another important consideration is how much time your family spends sitting (being sedentary). This includes “screen time”, which is the time spent in front of a screen such as a TV, computer, or video game. The guidelines recommend no screen time for children under 2 years of age, and 2 hours or less a day for all other ages. Don’t be a couch potato! Get moving! For more advice on activities, see our Resources page!

Medications are rarely needed in children. If cholesterol problems are detected at a young age, then focused, healthy changes in nutrition and exercise can make a big impact. However, one of the reasons for testing cholesterol levels in all children is to find those children and families with a disorder called Familial Hypercholesterolemia (FH) (See also Why test cholesterol in kids?). Individuals with FH can develop artery blockages and health problems at young ages due to an inherited and more severe cholesterol problem. If your child has elevated cholesterol that is not responding to diet changes, then you may want to see an expert in cholesterol problems in children, such as a lipidologist, to discuss medications before starting them. Current guidelines recommend seeing a lipid specialist if a child’s LDL cholesterol is >250mg/dL, triglycerides are >500mg/dL, or if a child has had an intolerance to medication or a child’s cholesterol has not responded to a trial of medication. You can learn more information about FH from:​ The FH Foundation: www.thefhfoundation.org ​Learn Your Lipids: www.learnyourlipids.com You can find a cholesterol specialist in your area at: National Lipids Association: Find a Member

If your child’s cholesterol seems very elevated, it is very important that you speak with a healthcare provider who has advanced training in cholesterol management. There are many reasons for high cholesterol and some of the most severe problems are inherited and extremely important to identify and properly treat while still in childhood. A cholesterol specialist will help you identify if your child’s problem is related to very high LDL cholesterol, very high triglycerides, very low HDL cholesterol, or perhaps even a combination of issues. High cholesterol can be inherited or it can be due to medications your child is taking, or it can be a result of other health problems your child is experiencing. Finding the right specialist for your needs is important. Some cholesterol specialists are lipidologists, which means they carry a specific certification in addition to their traditional primary care or specialty training. You can find these specialists in your area at the National Lipid Association Website. Be sure to set the “specialty” search filter to “Pediatrics” so that you find providers who have expertise in children. You may also search the web for “Lipid Clinics” in your area. They are often located in tertiary care centers such as Children’s Hospitals. There are some wonderful foundations that help support families facing severe cholesterol problems. After you speak to your own healthcare provider and a specialist in cholesterol management, you will likely be given a diagnosis for your child’s cholesterol problem. Depending on the diagnosis you are given, you can often find quality information that best fits the diagnosis. Websites addressing some of the inherited cholesterol problems include: The FH (Familial Hypercholesterolemia) Foundation – Children with FH page The Lp(a) Foundation Web MD also addresses some of the more severe cholesterol problems: Very high LDL cholesterol – Familial Hypercholesterolemia – FH PLEASE REMEMBER THAT YOU SHOULD NEVER DIAGNOSE YOURSELF OR YOUR CHILD ONLINE! Seek medical advice first, and then use trusted sources on the internet to supplement that information.