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by Stahl RJ

High Cholesterol in Children

(Hypercholesterolemia in Children)

Definition

High cholesterol is a higher than normal level of cholesterol in the blood. It is more common in adults but can occur in children.
There are two main types of cholesterol. One is high density lipoproteins (HDL) or good cholesterol. High levels of HDL have been linked to a lower risk of heart disease. The second type is called low density lipoproteins (LDL) or bad cholesterol. High levels of LDL cholesterol can lead to blockages in the blood vessels. This can lead to heart attacks and strokes .
Heart Attack
Heart Attack
Blockages in the blood vessels can lead to heart attacks.
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Causes

High cholesterol may be caused by a combination of factors, such as:
  • A high-fat diet and low activity levels
  • Being overweight or obese
  • Being prone to high cholesterol due to your genes

Risk Factors

Risk factors include:
  • Obesity
  • Having a family history of high cholesterol or heart disease or stroke
  • Having high blood pressure
  • Smoking
  • Having certain conditions (eg, diabetes, kidney disease , underactive thyroid)
  • Some medicines (eg, steroids, isotretinoin [acne medicine], beta-blockers, protease inhibitors, diuretics, cyclosporin)

Symptoms

High cholesterol does not usually cause any symptoms.

Diagnosis

Screening tests help doctors identify children who have high cholesterol. The screening recommendations are:
  • 2-8 years old— no screening needed unless there are risk factors
  • 9-11 years old—should be screened at least once
  • 12-17 years old—no screening needed unless there are risk factors
  • 17-21 years old—should be screened at least once
Screening is done by testing the lipid levels in the blood, for example:
  • Total cholesterol (the total amount of cholesterol in the blood)
  • HDL—good cholesterol
  • LDL —bad cholesterol
  • Triglycerides (type of fat that can also help predict the risk of future heart disease)
Note: Normal cholesterol levels are different for children than for adults. The doctor will use different cut-off points for diagnosing high cholesterol in your child.
In addition to the blood test, the doctor will:
  • Ask about your child’s symptoms.
  • Take your child’s medical history.
  • Do a physical exam.

Treatment

Lifestyle changes are a very important part of treatment.

Diet

Your doctor may recommend that you make changes to your child’s diet, such as:
The doctor may refer you and your child to a registered dietitian. They may also be referred to weight loss clinics or cardiologists if very high. In fact most pediatricians would not use statins without a cardiologist recommendation
The doctor may refer your child to a:
  • Registered dietitian
  • Weight loss center
  • Cardiologist (especially if statins may need to be prescribed)

Physical Activity

Other lifestyle changes include:
  • Encourage your child to participate in moderate or vigorous exercise every day. Examples include running, doing gymnastics, or playing soccer.
  • Limit the amount of time your child spends in front of a screen. This includes watching TV, playing video games, or using the computer. Aim for less than two hours in front of a screen per day.

Medicine

The doctor may recommend cholesterol-lowering medicine, like statins. Medicine is most often recommended if cholesterol is very high or your child has many risk factors for heart disease.

Prevention

For most children, high cholesterol can be prevented with healthy lifestyle habits such as:
  • Eating a diet that is rich in fruits, vegetables, and whole grains
  • If your child is overweight, follow a safe weight loss program. Use a program recommended by your doctor or dietitian.
  • Encourage your child to participate in physical activity on a regular basis.
  • Talk to your child about the dangers of smoking.
  • Be a good role model for your child. For example, eat healthy food and participate in physical activities as a family.

RESOURCES

American Heart Association
http://www.americanheart.org/
National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/

CANADIAN RESOURCES

Canadian Cardiovascular Society
http://www.ccs.ca/home/index%5Fe.aspx/
Heart and Stroke Foundation of Canada
http://www.heartandstroke.com/

References

Cholesterol levels in children and adolescents. American Academy of Pediatrics, Healthy Children.org website. Available at: http://www.healthychildren.org/English/healthy-living/nutrition/Pages/Cholesterol-Levels-in-Children-and-Adolescents.aspx. Updated December 21, 2011. Accessed June 27, 2012.
High cholesterol levels in children. American Academy of Pediatrics, Healthy Children.org website. Available at: http://www.healthychildren.org/English/ages-stages/gradeschool/nutrition/Pages/High-Cholesterol-Levels-in-Children.aspx. Updated January 17, 2012. Accessed June 27, 2012.
Hypercholesterolemia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated May 17, 2012. Accessed June 27, 2012.
NHLBI integrated guidelines for pediatric cardiovascular risk reduction. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated February 28, 2012. Accessed June 19, 2012.
Nutrition and health for young people. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/healthyyouth/nutrition/facts.htm. Updated January 20 , 2012. Accessed June 27, 2012.

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