Why test cholesterol in kids?

What problems can be found during cholesterol testing? Why test?

Guidelines have previously recommended checking cholesterol levels in children with certain risk factors.  Unfortunately that selective screening was not as effective, missing 30-60% of children with significant cholesterol problems.  The change to checking ALL children surprised many.  Part of the reason for the broader testing is to identify a disease called Familial Hypercholesterolemia (FH).  It occurs in 1 in 250-300 people in America and, in its most severe form, can lead children to start developing blockages in their arteries during childhood and adolescent years.  Most people with FH can be diagnosed by a cholesterol blood test along with a family history of premature heart disease.  In a family that is unaware that they have FH, the first signs can be when a family member has a heart attack.  Many people with FH have a normal body weight.  Since you can’t feel high cholesterol, many people with FH are first diagnosed when they get the routine blood test.  Universal screening of children helps identify those children so that they can learn about healthy choices and treatment options before their arteries start to show signs of plaque (blockages).

To learn more about FH, visit the FH Foundation: theFHFoundation.org

The newest American Heart Association/American College of Cardiology 2018 Guidelines for Cholesterol also recommend screening children for cholesterol problems:  Guideline on the Management of Blood Cholesterol

The American Heart Association also published a Scientific Statement in 2019 Regarding Cardiovascular prevention in children: Cardiovascular Risk Reduction in High-Risk Pediatric Patients


When should children have their cholesterol tested?

As mentioned, in 2011, new guidelines recommended that ALL children, at certain ages, have their cholesterol tested.  This is something called “Universal Screening”.  So what does that mean?  At what ages is it appropriate to check a child’s cholesterol?  If children already carry a “risk factor” for developing heart disease in the future, then they should have their cholesterol tested before age 9.  If they have no other risks, then it is reasonable to wait until between the ages of 9 and 11 to test a child’s cholesterol.  These same guidelines also recommend rechecking a child’s cholesterol between the ages of 17 and 21.  These recommendations were updated and supported in the 2018 AHA/ACCGuideline on the Management of Blood Cholesterol and the AHA 2019 Scientific Statement Cardiovascular Risk Reduction in High-Risk Pediatric Patients.

So to review:

Universal screening recommendations:
Risk factors?  Screen, at any age (especially after age 2).
Routine screening, with no risk factors?  Test between ages 9 to 11, and again between ages 17 to 21.

The ages when screening of kids cholesterol is done are crucial times in a child’s growth and maturity.  Between 9 and 11 many children are experiencing the onset of puberty.  They are also becoming “pre-teens” who are starting to make their own decisions…and develop their own habits.  This is a great time to discuss your family’s wellness strategy with your primary care provider.  How are you doing?  Are there choices your child is making that worry you?  Are you a good role model of wellness for your child?  No one is perfect, so don’t worry.  Take this opportunity to take a snapshot of your family’s wellness and then set goals for the next year or more.

The next age group for routine screening is between the ages of 17 and 21.  At this stage, your child is progressing into young adulthood.  They have new responsibilities, new pressures, and new priorities.  How can you and your child’s primary care provider work together to ease this transition and support them in making healthy choices?