Children and Cholesterol

If you, your parents, or your parents' siblings had a heart attack before age 55 and you have a child, this advice from the American Academy of Pediatrics (AAP) might surprise you: Have your child's cholesterol tested.

Under certain circumstances, the AAP says, cholesterol-lowering diets, under a pediatrician's supervision, are safe for children.

Which children need testing?

The AAP recommends that all children be screened for high cholesterol between ages 9 and 11, and again between ages 17 and 21. Children should be screened regardless of family history, the AAP says. In addition, the AAP and the National Heart, Lung, and Blood Institute recommend that children at 10 years old (or when puberty begins) who have risk factors such as overweight, obesity, or a family history be tested for type 2 diabetes. This test looks at fasting glucose levels.

Your child's health care provider will evaluate your child's diet, exercise habits, and body mass index and order a cholesterol screening, if needed. If your child has a total cholesterol level of greater than 200 mg/dL, the doctor may do a full screening, including HDL ("good") cholesterol, LDL ("bad") cholesterol, and triglycerides. If your child has an LDL level of 164 mg/dL or higher, the doctor may do a more extensive evaluation.

What are the best numbers?

For children and adolescents ages 2 to 19, these are the best results:

•    Fasting total cholesterol: less than 170 mg/dL, optimal; 170 to 199 mg/dL, borderline high
•    Fasting LDL cholesterol: less than 110 mg/dL, acceptable; 110 to 129 mg/dL, borderline; 130 mg/dl or more, the child should be screened for causes
•    HDL: greater than 45 mg/dL, acceptable; less than 40 mg/dL, high risk
How to cut cholesterol
Begin healthy habits early, and remember that children mimic your habits. The AAP and other experts offer these tips:
•    Choose healthier eating habits for yourself. Your children will follow your example.
•    Pack your kids' lunch. Prepare meals of no more than 30 percent of calories from fat and try to balance the types of fats included (polyunsaturated, monounsaturated. and saturated).
•    Cut back on fried foods, pastries, and cracker and chip snacks. These are high in fat and salt. Also limit cheese, high-fat spreads such as butter, margarine, and mayonnaise, and salad dressings. Use fresh fruits, fresh vegetables, and low-fat salad dressings instead.
•    Allow children no more than one or two fast-food meals a week.

Remember that children have special nutritional needs. Check with your child's health care provider or a registered dietitian before making any drastic changes in your child's physical activity or diet.