A child can have high cholesterol because of their genetics or their lifestyle habits. Your child may have a higher risk if they:
Have a family history of high cholesterol or early history of heart attacks or strokes
Eat a lot of processed foods or snack foods, fast food or sugary beverages
Do not get much physical activity
All children should have their cholesterol checked between ages 9-11. This test can be done by your child’s pediatrician during a Well Child visit.
What is cholesterol?
Cholesterol is a waxy substance that floats in our blood. It helps make things like vitamins and hormones, but in too high amounts can lead to heart disease, like heart attacks or strokes.
LDL is the bad cholesterol (think “L" for "lousy”)
HDL is the good cholesterol (“H” for "happy”)
Triglycerides are a fatty substance in the blood that floats with cholesterol.
LDL levels should be less than 110 mg/dL. HDL should be above 45 mg/dL. Triglycerides vary based on a child’s age and whether they fast before the test. For fasting tests, triglycerides should be less than 90 for children ages 10 and older and less than 75 for children 9 and under.
If you have a family history of high cholesterol or early heart attacks or strokes, your doctor may order a lipoprotein (a) test. Lipoprotein (a) is attached to the LDL cholesterol and if it is high, makes the LDL extra “sticky.” Having high lipoprotein (a) – even with a normal LDL – can increase the risk of heart attack and stroke.
Learn more
Treatment for high cholesterol first focuses on making healthy lifestyle choices, including diet and exercise.
Healthy eating
All children can benefit from these healthy eating tips:
Increase fruits and vegetables and decrease processed foods as much as possible
Increase fiber with more whole grains, beans, broccoli, spinach or carrots
Use olive oil or canola oil instead of butter
Avoid sugary drinks like juice, soda or sports drinks
Save bakery products for special occasions
Grill or bake foods instead of frying them
Replace french fries at restaurants with a fruit or vegetable for a side
Eat chicken and fish more often and limit red meat consumption (such as beef)
Drink skim or 1% milk (chocolate milk should be a treat)
Drink water all throughout the day (50-60 ounces of water per day)
Eat meals together as a family
More heart-healthy eating tips
Activity
It can seem like kids have endless energy sometimes but they don’t always get the amount of exercise they need. The goal is for one or more hours of activity per day.
For kids who may not be active on a regular basis, start small and aim for just 10 minutes a day. Once you start to make it a habit, you can increase the amount of time until you reach that one-hour goal.
Activity ideas
Great ways to get children moving include:
Walking
Hiking
Swimming
Running
Jumping rope
Games of tag
Dancing
Get the whole family involved with activities such as an after-dinner walk or weekend hike in a local park.
Limit screen time to less than 2 hours per day (this includes TV, tablets, computers, and video games).
For more ideas, check out local health clubs like the YMCA or community recreation leagues for organized opportunities like swimming lessons or team sports such as soccer or basketball.
When medications might be used
In children with really high cholesterol that doesn’t change with lifestyle changes or a strong family history of early heart disease, a statin medication may be used.
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Children between the ages of 9 to 11 and 17 to 21 should have their cholesterol checked, including non-fasting lipids or their total cholesterol and HDL.
Fasting lipids
Fasting lipids should be checked between the ages of 2 and 8, or 12 and 16 if the child has any of the following risk factors:
Family history (MI, CABG, sudden cardiac death in males <55, females <65)
Obesity
Diabetes (Type I or II)
Kidney disease or history of kidney transplant
Heart transplant
Kawasaki disease
Chronic inflammatory disease
HIV
Childhood cancer survivor
When to refer to the Pediatric Preventive Cardiology Clinic
When to order a fasting panel for a child and refer to the clinic:
LDL >110
HDL <45
Trig >110 on a non-fasting panel in children ages 2-9 or >130 in children ages 10-19
non-HDL >145
If the patient has abnormal fasting lipids, especially if the patient has risk factors listed above.
IF LDL >190 or TG >500 at any time