Cholesterol screening in children: Why it's important
1/13/2025 by Leslie Saba, M.B., B.Ch., B.A.O.
What is cholesterol?
Cholesterol is a waxy, fat-like substance found in every body cell. It plays many important roles, including producing hormones, vitamin D and bile acids that help digest foods. The body gets cholesterol from two sources: the liver and the foods we eat.
There are different types of cholesterol. Low-density lipoprotein (LDL) cholesterol is often called the "bad" cholesterol, as high levels can result in cholesterol deposits on the walls of arteries leading to plaque formation. On the other hand, high-density lipoprotein (HDL) cholesterol is known as the "good" cholesterol because it helps remove excess cholesterol from the arteries.
Why does it matter?
Hypercholesterolemia, or high cholesterol, occurs when too much cholesterol is in the blood. If cholesterol levels are high, plaque build-up can narrow arteries in the heart and brain, leading to an increased risk of heart attack and stroke over time. Studies have shown that this process of plaque build-up, also known as atherosclerosis, can begin in children.
What causes high cholesterol?
Genetics: Inherited conditions can cause high cholesterol levels, even in children. Some of these conditions can be relatively common, such as familial hypercholesterolemia, which is found in about 1 in 250 people.
Diet: Certain foods, mainly those high in saturated or trans fats, can increase cholesterol levels.
Weight: Being overweight or having obesity can lead to increased cholesterol levels.
Other underlying health conditions: Certain health conditions, such as diabetes, hypothyroidism, and kidney or liver disease can contribute to high cholesterol levels.
Why is it important to check cholesterol levels in children?
Hypercholesterolemia often does not show any symptoms until it leads to serious health problems, such as heart attack or stroke. Therefore, early detection and management through screening can help prevent those issues from developing.
The American Academy of Pediatrics recommends cholesterol screening for ALL children between ages 9 and 11 and again between ages 17 and 21. If your child has certain risk factors, such as a family history of high cholesterol or early heart disease, then screening may be recommended sooner, between ages 2 and 8. Cholesterol screening is done by a blood test measuring different cholesterol types.
How is high cholesterol managed in children?
- Well-balanced diet: Encourage a diet rich in fruits, vegetables, whole grains, lean proteins and healthy fats. Mono- and polyunsaturated fats, found in avocados, salmon, olive or canola oil, nuts and seeds, should be favored, while saturated and trans fats, present in red meat, full-fat dairy products, fried foods and margarine, should be limited. Meeting with a nutritionist is advised if any dietary changes are recommended.
- Regular physical activity: Aim for at least 60 minutes of moderate to vigorous physical activity daily.
- Limit screen time: Non-academic screen time should be limited to 1-2 hours per day.
- Avoid smoking or smoke exposure.
- Medications: Sometimes, medication may be prescribed to help lower cholesterol levels. Talk to your child's primary care clinician for more information.
Leslie Saba, M.B., B.Ch., B.A.O., is a Pediatric and Adolescent Medicine resident in Rochester, Minnesota. After residency, she will complete her fellowship in Pediatric Endocrinology at Mayo Clinic.