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High cholesterol - children

Lipid disorders - children; Hyperlipoproteinemia - children; Hyperlipidemia - children; Dyslipidemia - children; Hypercholesterolemia - children

Cholesterol is a fat (also called a lipid) that the body needs to work properly. There are many types of cholesterol. The ones talked about most are:

• Total cholesterol - all the cholesterols combined
• High density lipoprotein (HDL) cholesterol - called good cholesterol
• Low density lipoprotein (LDL) cholesterol - called bad cholesterol

Too much bad cholesterol can increase the chance of getting heart disease, stroke, and other problems.

This article is about high cholesterol in children.

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Causes

Most children with high cholesterol have one or more parent who has high cholesterol. The main causes of high cholesterol in children are:

• Family history of high cholesterol
• Being overweight or obese
• Unhealthy diet

Certain health conditions can also lead to abnormal cholesterol, including:

• Diabetes
• Kidney disease
• Liver disease
• Underactive thyroid gland

Several disorders that are passed down through families lead to abnormal cholesterol and triglyceride levels. They include:

• Familial hypercholesterolemia
• Familial combined hyperlipidemia
• Familial dysbetalipoproteinemia
• Familial hypertriglyceridemia

Exams and Tests

A cholesterol test is done to diagnose high blood cholesterol.

Guidelines from the National Heart, Lung, and Blood Institute recommend screening all children for high cholesterol:

• Between ages 9 and 11 years
• Again between ages 17 and 21 years

However, not all expert groups recommend screening all children and instead focus on screening children at higher risk. Factor that increase a child's risk include:

• The child's parents have total blood cholesterol of 240 mg/dL or higher
• The child has a family member with a history of heart disease before age 55 in men and age 65 in women
• The child has risk factors, such as diabetes or high blood pressure
• The child has certain health conditions, such as kidney disease or Kawasaki disease
• The child is obese (BMI in 95th percentile)
• The child smokes cigarettes

General targets for children are:

• LDL -- Less than 110 mg/dL (lower numbers are better).
• HDL -- More than 45 mg/dL (high numbers are better).
• Total cholesterol -- Less than 170 mg/dL (lower numbers are better).
• Triglycerides -- Less than 75 for child up to 9 years and less than 90 for child ages 10 to 19 years (lower numbers are better).

If cholesterol results are abnormal, children may also have other tests such as:

• Blood sugar (glucose) test to look for diabetes
• Kidney function tests
• Thyroid function tests to look for an underactive thyroid gland
• Liver function tests

Your child's health care provider also may ask about a medical or family history of:

• Diabetes
• Hypertension
• Obesity
• Poor food habits
• Lack of physical activity
• Tobacco use

Treatment

The best way to treat high cholesterol in children is with diet and exercise. If your child is overweight, losing excess weight will help treat high cholesterol. But you should not restrict your child's diet unless your child's provider recommends it. Instead, offer healthy foods and encourage physical activity.

DIET AND EXERCISE

Help your child make healthy food choices by following these guidelines:

• Eat foods that are naturally high in fiber and low in fat, such as whole grains, fruits, and vegetables
• Use low-fat toppings, sauces, and dressings
• Avoid foods that are high in saturated fat and added sugar
• Use skim milk or low-fat milk and milk products
• Avoid sugary drinks, such as soda and flavored fruit drinks
• Eat lean meat and avoid red meat
• Eat more fish

Encourage your child to be physically active. Children ages 5 years and older should be active at least 1 hour a day. Other things you can do include:

• Be active as a family. Plan walks and bike rides together instead of playing video games.
• Encourage your child to join school or local sports teams.
• Limit screen time to no more than 2 hours a day.

Other steps include teaching children about the dangers of tobacco use.

• Make your home a smoke-free environment.
• If you or your partner smoke, try to quit. Never smoke around your child.

DRUG THERAPY

Your child's provider may want your child to take medicine for cholesterol if lifestyle changes do not work. For this the child must:

• Be at least 10 years old.
• Have an LDL cholesterol level 190 mg/dL or higher after 6 months of following a healthy diet.
• Have an LDL cholesterol level 160 mg/dL or higher with other risk factors.
• Have family history of cardiovascular disease.
• Have one or more risk factors for cardiovascular disease.

Children with very high cholesterol may need to start these medicines earlier than age 10. Your child's doctor will tell you if this may be needed.

There are several types of drugs to help lower blood cholesterol levels. The drugs work in different ways. Statins are one kind of drug that lowers cholesterol and has been proven to reduce the chance of heart disease.

Outlook (Prognosis)

High cholesterol levels can lead to hardening of the arteries, also called atherosclerosis. This occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques.

Over time, these plaques can block the arteries and cause heart disease, stroke, and other symptoms or problems throughout the body.

Disorders that are passed down through families often lead to higher cholesterol levels that are harder to control.

References

Brothers JA, Daniels SR. Special patient populations: children and adolescents. In: Ballantyne CM, ed. Clinical Lipidology: A Companion to Braunwald's Heart Disease. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 37.

Bredefeld CL, Lau R, Hussain MM. Lipids and dyslipoproteinemia. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 18.

Daniels SR, Couch SC. Lipid disorders in children and adolescents. In: Sperling MA, ed. Sperling Pediatric Endocrinology. 5th ed. Philadelphia, PA: Elsevier; 2021:chap 25.

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Defects in metabolism of lipids. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 104.

Meeusen JW, Ueda M, Nordestgaard BG, Remaley AT. Lipids and lipoproteins. In: Rifai N, Chiu RWK, Young I, Burnham CAD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. St Louis, MO: Elsevier; 2023:chap 36.

Park MK, Salamat M. Dyslipidemia and other cardiovascular risk factors. In: Park MK, Salamat M, eds. Park's Pediatric Cardiology for Practitioners. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 33.

US Preventive Services Task Force; Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for lipid disorders in children and adolescents: US Preventive Services Task Force Recommendation Statement. JAMA. 2016;316(6):625-633. PMID: 27532917 pubmed.ncbi.nlm.nih.gov/27532917/.

Review Date: 7/3/2022  

Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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