New Cholesterol Guidelines for Kids

The lure!........................ The bad guy?........................ The problem.

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On 7/7/08, the American Academy of Pediatrics issued new guidelines for monitoring and treating children with high blood cholesterol levels.* The stakes couldn't be higher. At issue is whether we pediatricians and parents can prevent long term cardiovascular disease in our children by detecting high cholesterol levels early on and by promptly intervening to lower those levels.

The problem is (as I will discuss), the scientific returns are not in as yet, so this is an open question about which you should keep current and discuss with your pediatrician. Because it's so important, I've read the guidelines very carefully. As your faithful cyber-pedi (or am I your pedi robo-cop?), I wanted to share my thoughts.

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First, what do the guidelines recommend?

1. Most importantly, a healthy diet and increased physical activity for all children, including low-fat dairy products for all children over two years of age.


2. Low-fat dairy products for children 12 - 24 months who are overweight.


3. Screening (a fasting lipid profile) - starting at age 2 years and then every 3-5 years - for all children and adolescents with a family history of high cholesterol / high fat levels or early cardiovascular disease.


4. Screening for all children whose family history is unknown or who are overweight, have high blood pressure, or diabetes.


5. Weight management should be the primary treatment for overweight kids with high lipid levels.


6. For patients 8 years and older with an LDL concentration greater than 190 mg/dL (or 160 mg/dL with a family history of early heart disease or two additional risk factors present; or 130 mg/dL if diabetes is present), medications should be considered.

(LDL = low density lipoprotein = the bad guy cholesterol that appears to clog up the works, as opposed to HDL = high density lipoprotein = the good guy cholesterol that protects against atherosclerosis).

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What I like about the guidelines:

• The prevention of adult diseases during childhood is one of our great challenges. These guidelines reinforce that vital pediatric mission.


• It makes sense to me to aggressively intervene with children who already show signs of disease (diabetes, metabolic syndrome) or who are at great risk by virtue of genetics.


• The emphasis on a low animal fat, high fiber diet will serve to improve the health of all humans (see my blogs on this favorite subject of mine: Overweight toddler, overweight teen? Dr. P's 8 steps to a healthier family ).


• I like being given the OK to put chubby one year-olds on low fat milk products.

My concerns about the guidelines:

• I wish they had put more emphasis on fitness, i.e., more exercise for our kids (see my blog: Your teen's physical fitness). Even an overweight child can and should be physically fit, just as even a skinny child can be an unrepentant couch potato.


• Since we know that artery clogging atherosclerosis begins in childhood, it makes sense to intervene early. But, in fact, we don't really know whether lowering cholesterol levels in childhood will, in any significant way, prevent long term cardiovascular disease. Since that is the case, our interventions should at least "do no harm".


• The potential short-term and long-term consequences of using cholesterol-lowering agents during childhood simply aren't known. Just because they appear to be safe in old fogies like me doesn't mean that they couldn't have some sort of unanticipated effect on the growing, changing child's body (especially since cholesterol and fatty acids are essential building blocka for many organs, including the brain).


• For that reason - and until long term studies are done and we know more - unless the risks seem especially high, I'm still not going to recommend medications for my healthy pediatric patients with high cholesterol levels.


• I worry about you all needlessly obsessing about a high cholesterol level in your otherwise healthy, happy, active child, especially since we don't really know what it will mean for your child over time.


• I worry (hey, I worry a lot!) about the loss of a carefree childhood. As I wrote in my old blog: What is lost from childhood when the glorious taste of a hot fudge sundae is confounded by the worry that it is causing blood vessel sludge?

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Dr. P's bottom line: Unless your child has one of the risk factors listed above, don't worry about their cholesterol 'number'. Worry instead about their general fitness and nutritional well-being. Feed them a healthy, low animal fat, low junk food, high fiber diet, make sure they get plenty of exercise, and you'll be doing a superb job.

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* "Lipid Screening and Cardiovascular Health in Childhood"
Daniels S, Greer F and the Committee on Nutrition

Related Topics:

• Kids to Get Heart Disease Screening
• Helping Your 'Not-Thin' Kids

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