Is my child at risk for high cholesterol?

When you think about high cholesterol, you may picture an older person enjoying a porterhouse steak or bowl of chocolate mousse. And, peering inside the body, you might visualize a waxy, fatty substance that’s all bad, all the time.

Those impressions are partly true. Having excessively high levels of cholesterol can clog your arteries and, eventually, cause heart disease, the leading killer of American adults.

But everyone needs a certain amount of cholesterol to be healthy. It’s an essential part of your body’s cells, a vital component in the production of hormones, and it aids digestion, too. And all people—children and adults alike—are susceptible to having unhealthy levels of cholesterol.

Kids and cholesterol, by the numbers

Just over 7 percent of American kids aged 6 to 19 years of age have high cholesterol levels, according to a report from the American Heart Association published in Circulation in 2020. Research shows a significant link between having high cholesterol at a young age and elevated risks of heart problems in adulthood.

A 2020 study published in the Journal of the American College of Cardiology found that teenagers with high cholesterol levels were more likely to experience heart disease, stroke, heart failure, or cardiovascular death as adults.

Cholesterol basics

Cholesterol comes in two main forms: low-density lipoprotein (LDL) and high-density lipoprotein (HDL). LDL is the “bad” kind of cholesterol that can block your arteries, leading to a host of heart problems, like heart attack, stroke, coronary heart disease, and high blood pressure. HDL is the “good” kind, which helps carry excess LDL cholesterol from the arteries to the liver, where it’s passed out of the body.

LDL levels are affected by diet, age, exercise, and your genes. Over time, a diet high in saturated and trans fats and too little exercise can cause cholesterol to build up in your arteries. Though adults are typically more susceptible to heart disease, the rise in obesity among Americans raises concerns about children because obesity is a main risk factor for high cholesterol. About 14.7 million children and adolescents in the United States are obese, according to the Centers for Disease Control and Prevention (CDC).

Children with high cholesterol may not feel the effects until later in life, but the risks are alarming, nonetheless.

Cholesterol screening for kids

A screening is a test that looks for signs of a disease before symptoms appear. It’s for someone who does not seem sick. It’s common for adults to be screened for cholesterol issues. But screening practices for kids are a different story, and recommendations differ among major health organizations.

The U.S. Preventive Services Task Force (USPSTF), for example, is an independent panel of experts that makes recommendations for primary care. They’ve found there isn’t enough evidence that screening is helpful for people ages 20 and younger without symptoms of a cholesterol issue.

Due to the prevalence of obesity, however, the American Academy of Pediatrics (AAP) recommends screening for high cholesterol between ages 9 and 11 and again between ages 17 and 21. The AAP also recommends children between the ages of 2 and 10 be screened if they have one or more of these risk factors:

• Parents or grandparents who have suffered a heart attack or have blocked arteries at age 55 or earlier in men or 65 or earlier in women
• Parents or grandparents with cholesterol levels of 240 mg/dL or higher
• Unknown family health background
• Characteristics associated with heart disease, such as high blood pressure, diabetes, obesity, and smoking

Ultimately, more research on the effectiveness of cholesterol screening is needed. In the meantime, talking to a trusted healthcare provider can help you decide whether your own child should be screened.

How parents can help

“Some small percentage is genetic, but a high percentage of obesity is more environmental,” says Nora Bolanos, MD, a pediatrician in Kissimmee, Florida. “It's connected to physical activity and how many calories they're taking in.”

There’s another connection between obesity in parents and their children.

“Once we detect a child with a high level of cholesterol, we start the child and the family on a plan,” Dr. Bolanos says. This typically includes a low-cholesterol, low-fat diet and exercise regimen. A diet rich in vegetables, lean proteins, and whole grains can help lower a child’s intake of artery-blocking fats.

“There needs to be teamwork between parents, the pediatrician, and even the school, because that's where kids get a lot of their fatty food,” she says. Since changing the school menu isn’t likely, it’s all the more important for children to know how to make the healthiest picks in the cafeteria and how to eat well outside of school.

When to get your child retested

If your child was found to have high cholesterol, Bolanos recommends screening your child again after about three months of diet and exercise. If the child has adhered to a healthy diet and increased activity and the cholesterol levels still haven’t gone down, your child may be referred to a specialist. An endocrinologist or cardiologist may consider starting your child on cholesterol medication.

In 2018, the American College of Cardiology and the American Heart Association released guidelines on managing high cholesterol levels. For children with a family history of high cholesterol, they recommend using statin medication for children 10 years and older who have not seen any improvement after 3 to 6 months in therapy. In rare cases, statins would be acceptable for an 8-year-old if they showed “extremely elevated” cholesterol levels and had a “concerning family history.”5

Even with medication, it’s important to keep children on a healthy diet plan and encourage plenty of exercise. The American Heart Association recommends limiting intake of saturated fats to 5 to 6 percent of daily calories. Trans fat and dietary cholesterol intake should be as low as possible. Limiting the amount of fast food and processed food a child eats is a simple and effective way to improve their cholesterol levels. Reading the labels of packaged foods and drinks is also helpful in knowing how much fat is in the product.