High cholesterol - 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.
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:
- 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:
- Poor food habits
- Lack of physical activity
- Tobacco use
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.
Understanding cholesterol results - Animation
LDL cholesterol has gotten a bad reputation, and for very good reason. Having too much of this fatty substance in your blood can clog up your arteries, preventing blood from getting to your heart and out to where it's needed in your body. Checking your LDL levels can help your doctor spot high cholesterol before it can cause a heart attack or stroke. Let's talk today about LDL tests. LDL stands for low-density lipoprotein. Lipoprotein is a type of protein that transports cholesterol, as well as fats called triglycerides and lipids, in your blood. When you eat too many fatty, cholesterol-rich foods, LDL cholesterol can start to collect in your artery walls. That's one collection you don't want, because if a chunk of that gunk breaks loose and gets lodged in a blood vessel, you could end up having a heart attack or stroke. To check your LDL cholesterol level, you'll need to have a blood test. Your doctor may tell you not to eat or drink anything for 8 to 12 hours before the test, so you can get an accurate reading. During the test, your doctor will draw blood from one of your veins. The needle might sting a little bit, but the feeling shouldn't last for any more than a few seconds. So, how do you know that you have high LDL cholesterol? Well, your LDL cholesterol level (think L for Lousy) will usually be measured along with your HDL, or good cholesterol (think H for Healthy), as well as your triglycerides and your total cholesterol level. Together, these measurements are called a lipid panel. You want your LDL level to be at least below 130 mg/dl, but ideally less than 100 milligrams per deciliter. If you're at high risk of heart disease, it should be even lower than that - less than 70 milligrams per deciliter. And for folks of average risk of getting heart disease, anything over 160 is considered a high LDL level. If you do have LDL cholesterol, you could be at risk for heart disease. Now, some folks have high cholesterol because they have an inherited condition that causes high cholesterol. If your LDL is low, it may be because you're not eating a well-balanced diet or your intestines aren't absorbing the nutrients from the foods that you eat. Ask your doctor how often you should have your LDL, and total cholesterol levels, checked. Depending upon your heart disease risks, you may need to be tested more often. If your LDL cholesterol is high, ask your doctor about cholesterol-lowering medications, diet, and other ways to bring it back down into a normal range.
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:
Children should have many chances to play, run, bike, and play sports during the day. They should get 60 minutes of moderate activity every day. Mod...Read Article Now Book Mark Article
- 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.
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.
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.
Hardening of the arteries
Atherosclerosis, sometimes called "hardening of the arteries," occurs when fat, cholesterol, and other substances build up in the walls of arteries. ...Read Article Now Book Mark Article
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.
Charles I. Schwartz MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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