It is easy to recognize the current childhood obesity epidemic.
Most parents don't see the effects on those overweight kids though, such as:
- type 2 diabetes mellitus
- hypertension (high blood pressure)
- cardiovascular disease (coronary heart disease, heart attacks, etc.)
- high total cholesterol and LDL cholesterol levels ("bad" cholesterol)
- low HDL cholesterol levels ("good" cholesterol)
Cholesterol Screening
The effects of cardiovascular disease is something that will especially be a problem once an overweight child grows up, when he will be at risk for a heart attack or stroke.
Cholesterol screening can hopefully identify those who are most at risk at an early age to help prevent the development of cardiovascular disease.
The American Academy of Pediatrics recommends that at risk children should have a fasting lipid profile at a well child visit once they are two years old and by the time they are ten years old if they:
- have a positive family history that puts them at high risk, including:
- men at or under 55 and women at or under 65 with premature cardiovascular disease
- family members with dyslipidemia (high cholesterol)
- have family members who:
- are obese (have a BMI over the 95th percentile)
- are overweight (have a BMI between the 85th and 95th percentile)
- have high blood pressure
- have diabetes mellitus
- smoke cigarettes
- don't know their family history for cholesterol or cardiovascular disease
In addition, all children should be screened with a non-fasting non-HDL cholesterol between the ages of 9 and 11 years.
Cholesterol Levels
Like most things, cholesterol levels are different for kids, whose levels are:
- Acceptable if the total cholesterol is less than 170 and the LDL is less than 110
- Borderline if the total cholesterol is between 170 and 199 and the LDL is between 110 and 129
- Elevated if the total cholesterol is more than 200 and the LDL is more than 130
Fasting triglyceride levels above 150 and HDL levels less than 35 would also usually be considered abnormal.
Cholesterol levels that take into account a child's age and gender are also available and may be more useful, as the levels do vary with age, especially as a child goes through puberty.
Treatment for High Cholesterol
In the past, checking a child's cholesterol level wasn't that helpful because there wasn't that much to do about it. Sure you could provide advice on child nutrition and encouragement to get more physically active, especially if he was already overweight, but you likely were already doing that before you knew the child's cholesterol level, so knowing the level didn't really change anything.
Or maybe a child's high cholesterol level was the wake up call that some families needed to get every one into a more healthy lifestyle.
Anyway, the American Academy of Pediatrics still endorses dietary changes and weight loss to help lower a child's cholesterol for overweight children, likely with the help of a registered dietitian, including:
- limiting foods with trans fats and make sure they make up less than less than 1% of total calories each day
- restricting saturated fat to 7% of total calories each day (choose more low fat foods and foods with more poly-unsaturated and mono-unsaturated fats instead)
- restricting cholesterol to 200mg/day
It may also be helpful to have your child eat more high fiber foods and exercise each day.
But when these interventions don't work, the American Academy of Pediatrics does recommend that children who are at least eight years old be started on a medication to help lower their LDL levels, such as:
- Bile acid–binding resins
- Pravachol (pravastatin)
- Cholesterol-absorption inhibitors like Zetia (ezetimibe)
- Fibrates such as Lopid (gemfibrozil)
What You Need To Know
- If a child's fasting lipid profile is normal, then it should be repeated every three to five years.
- Since most adopted children don't know their family history for cholesterol or cardiovascular disease, they should likely have a fasting lipid profile some time between the ages of two and ten years.
- Most pediatricians don't have any experience prescribing cholesterol lowering medications, such as Pravachol, Zetia, or Lopid, so your child may need to see a pediatric lipid specialist (a pediatric cardiologist or a pediatric gastroenterologist) for treatment once your pediatrician identifies your child as having high cholesterol.
- The AAP now recommends that parents give their toddlers low fat milk if they are already overweight, have family members who are overweight, or a positive family history that puts them at high risk cardiovascular disease.
Sources:
American Academy of Pediatrics. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report. Pediatrics Vol 128 December 2012 Supplement 5.
American Academy of Pediatrics Clinical Report. Lipid Screening and Cardiovascular Health in Childhood. PEDIATRICS Vol. 122 No. 1 July 2008, pp. 198-208.
