High Cholesterol in Children
(Hypercholesterolemia in Children)
High cholesterol is a higher than normal level of cholesterol in the blood. It is more common in adults but can occur in children.
There are 2 types of cholesterol that may have the most significant effect on cardiovascular disease. One is high density lipoproteins (HDL) or good cholesterol. High levels of HDL have been linked to a lower risk of heart disease. The second type is called low density lipoproteins (LDL) or bad cholesterol. High levels of LDL cholesterol can lead to blockages in the blood vessels. This can lead to heart attacks and strokes.
Blockages in the blood vessels can lead to heart attacks.
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High cholesterol may be caused by a combination of factors, such as:
- Being prone to high cholesterol due to your genes
- Being overweight or obese
- A high-fat diet and low activity levels
Risk factors include:
- Having a family history of high cholesterol or heart disease or stroke
- Having high blood pressure
- Having certain conditions, such as diabetes, kidney disease, and underactive thyroid
- Some medications, such as steroids, isotretinoin [acne medicine], beta-blockers, protease inhibitors, diuretics, and cyclosporin
High cholesterol does not usually cause any symptoms.
Screening tests help doctors identify children who have high cholesterol. The screening recommendations are:
- 2-8 years old— no screening needed unless there are risk factors
- 9-11 years old—should be screened at least once
- 12-17 years old—no screening needed unless there are risk factors
- 17-21 years old—should be screened at least once
Screening is done by testing the lipid levels in the blood when your child is not fasting, for example:
- Total cholesterol (the total amount of cholesterol in the blood)
- HDL—good cholesterol
- LDL —bad cholesterol
- Triglycerides (a type of fat that can also help predict the risk of future heart disease)
Note: Normal cholesterol levels are different for children than for adults. The doctor will use different cut-off points for diagnosing high cholesterol in your child. If the values are high, they will be repeated when your child has been fasting.
In addition to the blood test, the doctor will:
- Ask about your child’s symptoms.
- Take your child’s medical history.
- Do a physical exam.
Lifestyle changes are a very important part of treatment.
Your doctor may recommend that you make changes to your child’s diet, such as:
- Choose healthy drinks. Opt for water and fat-free milk. Avoid sugar-sweetened drinks.
- Focus on fruits and vegetables, low-fat dairy products, and high- fiber food.
- Choose foods low in saturated fat, total fat, and cholesterol.
- Eat low- sodium foods.
- Pay attention to portion size.
- Eat breakfast every day. Have meals together as a family.
- Limit meals from fast food restaurants
The doctor may refer you and your child to a registered dietitian. Your child may also be referred to weight loss clinics or cardiologists if very high. In fact most pediatricians would not use statins without a cardiologist recommendation
The doctor may refer your child to a:
- Registered dietitian
- Weight loss center
- Cardiologist (especially if statins may need to be prescribed)
Other lifestyle changes include:
- Encourage your child to participate in moderate or vigorous exercise every day. Examples include running, doing gymnastics, or playing soccer.
- Limit the amount of time your child spends in front of a screen. This includes watching TV, playing video games, or using the computer. Aim for less than 2 hours in front of a screen per day.
The doctor may recommend cholesterol-lowering medication, like statins, if lifestyle changes are not helping. Medication is most often recommended if cholesterol is very high or your child has many risk factors for heart disease. This is usually prescribed by a specialist.
For most children, high cholesterol can be prevented with healthy lifestyle habits such as:
- Eat a diet that is rich in fruits, vegetables, and whole grains.
- If your child is overweight, follow a safe weight loss program. Use a program recommended by your doctor or dietitian.
- Encourage your child to participate in physical activity on a regular basis.
- Talk to your child about the dangers of smoking.
- Be a good role model for your child. For example, eat healthy food and participate in physical activities as a family.
American Heart Association
National Heart, Lung, and Blood Institute
Canadian Cardiovascular Society
Heart and Stroke Foundation of Canada
Cholesterol levels in children and adolescents. Healthy Children—American Academy of Pediatrics website. Available at: http://www.healthychildren.org/English/healthy-living/nutrition/Pages/Cholesterol-Levels-in-Children-and-Adolescents.aspx. Updated December 3, 2015. Accessed December 21, 2017.
High cholesterol levels in children. Healthy Children—American Academy of Pediatrics website. Available at: http://www.healthychildren.org/English/ages-stages/gradeschool/nutrition/Pages/High-Cholesterol-Levels-in-Children.aspx. Updated December 3, 2015. Accessed December 21, 2017.
Familial hypercholesterolemia. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T115368/Familial-hypercholesterolemia. Updated December 18, 2017. Accessed December 21, 2017.
NHLBI integrated guidelines for pediatric cardiovascular risk reduction. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T900917/NHLBI-integrated-guidelines-for-pediatric-cardiovascular-risk-reduction. Updated February 12, 2013. Accessed December 21, 2017.
Nutrition and the health of young people. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/healthyyouth/nutrition/pdf/facts.pdf. Updated January 20, 2012. Accessed December 21, 2017.
Last reviewed November 2018 by EBSCO Medical Review Board Kari Kassir, MD Last Updated: 7/13/2012