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.

"Up to one-third of children, from 2 years old through the teenage years, have high cholesterol," says New York pediatrician Marc S. Jacobson, M.D. "A lot of these kids have never been tested because most people are unaware there's a potential problem."

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

Which children need testing?

The AAP recommends cholesterol tests for children ages 2 and older and teens in these situations:

• A parent, parents, or grandparents had atherosclerosis before age 55.

• A parent, parents, or grandparents had a heart attack or vascular disease before 55.

• A parent or parents have cholesterol of 300 mg/dL or greater.

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

In some cases, the AAP suggests, children should be tested if they have a higher heart-disease risk because of smoking, high blood pressure, obesity, or diet, or if their parents' medical records aren't available.

What are the best numbers?

For children ages 2 to 18, these are the best results:

• Fasting total cholesterol: less than 170, optimal; 170 to 199, borderline high

• Fasting LDL cholesterol: less than 110, acceptable; 110 to 129, borderline; 130 or more, the child should be screened for causes

• HDL: greater than 35, acceptable; less than 35 is considered high risk

How to cut cholesterol

Begin healthy habits early, and remember that children mimic your habits. Michael Mogadam, M.D., cardiologist and author of the book Every Heart Attack Is Preventable, offers these tips:

• Choose healthier eating habits that your child will follow.

• Pack your kid's 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; cracker and chip snacks, which are high in fat and salt; cheese; high-fat spreads such as butter, margarine, and mayonnaise; and salad dressings. Use low-fat salad dressings instead.

• Allow your child no more than one or two fast-food meals a week.