The American Heart Association has been educating the adult population on the importance of “knowing their numbers” for years. Since 2011, the American Academy of Pediatrics has recommended that parents should know this information about their children as well.
“All kids get should get their cholesterol checked by age 11,” said Dr. Ann Liebeskind, a lipidologist, internist, pediatrician and owner of Mobile Health Team™, a private lipids practice serving individuals and families in Wauwatosa and Neenah, Wisconsin.
During a well-child visit, a primary care provider can help a child and their parents decide when and what test is the best fit for them based on a number of factors such as family history of premature heart disease.
A simple blood can screen for cholesterol.
“Whether the child has to fast depends on the level of risk,” said Dr. Liebeskind. “If there are health problems that are risk factors for heart disease, then a fasting cholesterol test will likely be needed.”
If the test is routine, then the provider could administer it that day without the child needing to fast.
The good news is most cholesterol problems that are caught on a routine screening can be addressed through focused changes diet and exercise.
A common myth is that only children who are obese have high cholesterol.
“While inactivity and poor diet leads to some very common cholesterol problems, not all come from obesity,” said Dr. Liebeskind. “Your child can still be at risk for cholesterol problems and, down the line, heart disease, even if they are of a normal weight.”
The current guidelines recommend a Child-1 diet as a starting point for management, as well as getting 60 minutes of active play every day and limiting screen time to less than two hours a day.
Moderate problems may need more attention such as trying specialized diets or working with a trained nutritionist.
“Severe problems, which are reserved for children who would otherwise develop heart disease by the time they are in their 20s or 30s, sometimes need medication,” said Dr. Liebeskind.
She notes that medications are not appropriate to treat the cholesterol of the vast majority of children being tested, only the small percent that are very high risk.
“If a child has a genetic cholesterol problem, it is much harder to manage by changing diet and exercise alone,” says Dr. Liebeskind.
Statistics report that inherited cholesterol problems can affect the long-term health of as many as 1 in 250 children in the United States.
Dr. Liebeskind explains that this number supports the severe disorder called Familial Hypercholesterolemia or FH.
“In FH, the child’s liver may not be able to clean up the LDL cholesterol from the blood effectively so they quickly accumulate large amounts of cholesterol,” she said. “So diet, exercise, and even some medications, will be less effective for them because their liver isn’t able to do its job correctly because its been programmed wrong due to an inherited problem.”
Many parents do not know their family history or relate it to affecting their child so it’s hard to identify the kids that are high risk
“Before this guideline was established, we were missing 30%-60% of abnormal cholesterol problems in children,” said Dr. Liebeskind. “Without a cholesterol blood test, you would never know they have high risk for heart disease.
She explains that atherosclerosis (heart artery disease) begins in childhood, especially in kids with problems such as FH. Depending on the cholesterol problem, the symptoms usually won’t surface until adulthood, but the disease itself has begun in childhood.
“We must start identifying and managing the risk factors in childhood if we truly want to prevent heart disease,” Dr. Liebeskind concluded.
While the recommendation came years ago, it wasn’t until February 2014 that pediatric materials changed this screening from optional to a best practice. This allowed for greater awareness among parents and also allowed insurance companies to begin to cover the screening for children.
“You must ‘know your numbers’ to really know your child’s risk,” said Dr. Liebeskind.
Text Source: Dana Baumgart – Right Doc Blog
