July 08 , 2008
Cholesterol screening of children
Joan Marie Pellegrini, MD
We know that that obesity is an ever-increasing epidemic. We also can now see that children are not being spared from this epidemic. We know that high cholesterol, particularly high LDL (the “bad” cholesterol), is dangerous to heart health. However, what about high cholesterol in children? Yesterday, the American Academy of Pediatrics issued their new guidelines. They are now recommending that children be screened for cholesterol at their routine check-ups. The new recommendations are targeting children with a BMI in the 95th percentile. BMI is a ratio of weight to height. The old guidelines in 1998 recommended cholesterol screening only for children with particularly concerning family histories of heart disease or inherited lipid disorders.
Autopsy studies have shown that cholesterol plaques in the arteries can start developing as early as 8 years old. Also, population studies have shown that heart health is largely determined by health during adolescence. These two facts, along with the growing obesity epidemic, have lead to the new recommendations. The new recommendations also call for low fat milk after age 1 in children that are at risk of obesity.
What does this mean for you and your child? Your pediatrician is not going to recommend screening for every child. They will first determine your child’s risk based on family history, BMI, health habits, and nutritional habits. If your pediatrician decides that your child is at risk, he or she may recommend a blood test to screen for cholesterol levels. Even if the levels are not good, your child will not necessarily be put on medication. The first approach would be diet and exercise modification. Medication is recommended only when diet and exercise fail to modify the cholesterol and triglyceride levels.
The biggest “take home” message from the AAP’s new recommendations is that we can no longer be complacent about children’s health in terms of obesity and cholesterol. Also, health problems during childhood are likely to impact health quality during the following years.