Should You Test Your Child's Cholesterol Level?

Photo Credit: Enrico Strocchi

A new trend in pediatrics is afoot: testing children's cholesterol levels. At first blush it makes sense, especially since we know that:

• High levels of cholesterol (>200) and their protein convoys in the blood ("low density lipoproteins" or LDL >130) are related to the formation of fatty plaques ("atherosclerosis") in the blood vessels. These blockages can one day lead to heart attacks and strokes.
• High cholesterol /LDL levels in children are caused by heredity, dietary intake of saturated fats and cholesterol, and obesity. Each of these risks is higher in U.S children, compared to other industrialized countries. You can guess why.
• Fatty plaques in blood vessels have already been found in the autopsies of adolescent (and even younger) children. This suggests that the process of atherosclerosis can begin in childhood.

So it seems reasonable to test cholesterol/LDL in childhood and to treat high levels sooner rather than later. After all, an ounce of prevention is worth a pound of cure.

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But is cholesterol testing kids really a slam dunk? I vote no. Here's why:

• Nearly half of children with high cholesterol levels will have normal levels as adults.
• The most effective treatment for high levels is medication ("statins") and these have never been tested, nor are they recommended, for use in childhood.
• It's not known if early treatment in childhood makes any long term difference in a process that takes decades for trouble to appear.
• Focusing solely on a number is rarely a good idea. I'm concerned that the testing will imply to some parents that their obese child with a normal cholesterol level should not be a concern and, alternatively, others will become unduly overwrought about their perfectly healthy child with a high number. Seems to me a set-up for both unwarranted reassurance and needless anxiety.

Finally, I'm worried about the ongoing erosion of an oblivious childhood. The time of childhood innocence seems to be ever more ephemeral. At increasingly earlier ages, kids are exposed to sexual content, to violence, to drugs, to world-wide catastrophes.

And, in the interests of "scaring them healthy," they are asked to envision what no child should: a future full of illness and woe. What does it mean to an eight year old to be constantly reminded that his "bad habits" could some day lead to a heart attack? What is lost when the glorious taste of a hot fudge sundae is confounded with the worry that it is causing blood vessel sludge?

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My advice is to forget about obtaining your kids' cholesterol level. More importantly, don't burden them with an explanation of the genesis of adult diseases, like atherosclerosis and its discontents. All a kid needs to know is that some things are "healthy" and some are not.

Fortunately, most healthy behaviors aren't all that much of a sacrifice. Exercise is fun! It's not a hardship to use low-fat milk and milk products (especially when that is all you have ever had). Cutting down on animal fat and fried food and dietary cholesterol and trans fats is not a big deal. More fruits and veggies, and moderation in eating junk foods and desserts, is a good habit for all to cultivate. Life without a lot of sugary drinks is still worth living (OK, some of you may argue that point).

My point is that all kids - really, all members of your family - should be instilled with the elements of a healthy life style, not just those with a high cholesterol level. And while we are at it, let's not unintentionally create a generation of hypochondriacs - children for whom the future ominously looms as a time not of joy but of calamity.

So here's to an oblivious and healthy childhood (as long as you can manage to make it last)!

Related Topics:

• WebMD Video: Tips for Parents to Help Their Kids Eat Right
• WebMD Video: Raising Kids to be Active for Life

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