Mrs. Chen sat across from me, her hands clasped tightly in her lap. The routine check-up for her son, eight-year-old Leo, had flagged something unexpected. High cholesterol, Doctor?’ she’d whispered, her voice barely audible. ‘But… he’s a kid. He runs around all day!‘ I see that flicker of disbelief, that knot of worry, in so many parents’ eyes when we talk about high cholesterol in children. It’s a curveball, for sure, especially when your child seems the picture of health. And often, that’s just it – there aren’t always obvious signs.
What is High Cholesterol in Children, Really?
So, let’s break it down. When we talk about high cholesterol in children (sometimes called pediatric high cholesterol), we mean that the levels of certain fats, or lipids, in their blood are higher than they should be. It’s not just cholesterol; kids and teens can also have high levels of another type of fat called triglycerides.
Now, we all need some lipids. They’re building blocks for our bodies. But, like many things, too much can start to cause problems down the line. How do we know if the levels are too high? We do a simple blood test called a lipid panel. What’s considered “normal” actually changes a bit as kids grow, so it’s different for them than it is for adults.
You’ll often hear about “good” cholesterol (HDL cholesterol) and “bad” cholesterol (LDL cholesterol). With HDL, we actually want that number to be higher, as it’s protective. It’s the LDL and triglycerides we worry about when they’re elevated.
Does High Cholesterol in Children Show Signs?
This is the tricky part: usually, no. Your child likely won’t have any obvious symptoms of high cholesterol. It’s often a silent issue, which is why screening can be so important, especially if there’s a family history.
However, if cholesterol levels are severely high, particularly due to genetic reasons, you might notice a few things:
- Waxy, fatty plaques appearing on their skin, which we call xanthoma.
- A little yellow bump on or near their eyelid, known as xanthelasma.
- Sometimes, white or grayish rings around the outer edges of their eyes, called corneal arcus. These are less common, but we watch for them.
Why Might My Child Have High Cholesterol?
It’s often a mix of things, rarely just one culprit. Several factors can influence your child’s cholesterol levels:
- What they eat: Diet plays a significant role, as you can imagine.
- How much they move: Regular physical activity is key.
- Other health bits: Conditions like obesity, diabetes, and a specific kidney issue called nephrotic syndrome can affect lipid levels.
- Certain medicines: Some medications can have an impact.
- Family history and genes: This is a big one. If your child has high cholesterol, there’s a good chance a biological parent also has a history of it or needs medication to manage their own levels.
The Role of Genes – It’s Often in the Family
Genetics can really steer the ship when it comes to pediatric high cholesterol. Let’s look a bit closer.
One condition we see is Familial Hypercholesterolemia (FH). Imagine inheriting a strong tendency for high “bad” cholesterol (that’s the LDL cholesterol) right from birth. It’s often a dominant condition, meaning just one gene from one parent can pass it on. We might suspect FH if a child’s LDL level is 160 mg/dL or higher without other clear reasons. If a parent has FH, even an LDL over 130 mg/dL in their child gets our attention.
Sometimes it’s not one single gene, but a “team” of them inherited from both parents that cause high LDL. This is what we call polygenetic causes. The LDL might creep up more slowly, perhaps not becoming very noticeable until the late teens or early adulthood. The heart risk is there, but generally less severe than with FH from a young age. Kids with FH often need medication sooner.
Then there’s another character called Lipoprotein (a), or Lp(a) for short. This is a specific type of cholesterol particle that can be passed down. Higher Lp(a) levels can increase the risk of coronary artery disease and, in rare cases, have been linked to strokes in childhood. We might check your child’s Lp(a) level if they:
- Have an FH diagnosis.
- Have had an ischemic stroke without a known cause.
- Have a biological parent with high Lp(a).
- Have a close relative (parent or sibling) who had a heart attack early in life.
And What About High Triglycerides?
High triglycerides in kids often tie back to:
- Obesity
- Diabetes
- Certain medications
Genetics can play a role here too, but it’s less common than with FH for cholesterol. If we see a fasting triglyceride level of 500 mg/dL or higher without other explanations, we start thinking about genetic factors.
What Could Happen Down the Road?
The main concern with long-term high LDL cholesterol in children is the buildup of plaque (atheroma) in their arteries. This silent process can, many years later, block blood flow and lead to serious problems like:
- Heart attack
- Stroke
- Peripheral artery disease (affecting blood flow to the legs)
It’s really about protecting their future heart health.
High triglycerides, on the other hand, can sometimes lead to an inflammation of the pancreas called pancreatitis, especially if levels are very high. Over long periods, they might contribute a bit to artery plaque, but LDL cholesterol is the bigger player there.
How Do We Find Out If It’s High Cholesterol?
It’s straightforward, thankfully. We diagnose high cholesterol in school-aged children with a simple blood test called a lipid panel.
Sometimes, we’ll ask your little one not to eat or drink anything but water for about 12 hours before the test – this is called fasting. We’ll always let you know if this is necessary for their specific test. Doing this test is especially important if there’s a strong family story of heart issues or if a parent has known high cholesterol. The results will clearly show us if your child’s cholesterol or triglyceride levels are too high.
Okay, We Have a Diagnosis. What Now? Managing High Cholesterol in Children
Hearing that your child has high cholesterol can be worrying, I get it. But the good news is, there’s a lot we can do.
First things first, we usually look at lifestyle. This means making some changes to what your child eats and how much physical activity they’re getting. Don’t worry, we’ll guide you every step of the way with practical advice.
When Might We Consider Medication?
For children aged 8 and older, if those lifestyle tweaks aren’t quite enough to bring cholesterol down to safer levels, or if the numbers are very high to begin with, medication might be on the table. We follow expert guidelines from organizations like the National Heart, Lung, and Blood Institute and the American Heart Association. Here’s a general idea of when we might talk about medication:
- LDL higher than 190 mg/dL: Even if your child has no other risk factors for heart disease.
- LDL 160 mg/dL or higher, if:
- Your child has other risk factors for cardiovascular disease.
- One parent has a history of an early heart attack or known plaque in their heart arteries.
- Diet and exercise changes haven’t hit the target cholesterol levels after about six months.
- LDL higher than 130 mg/dL, if:
- One parent has been diagnosed with FH.
- Your child has other risk factors like obesity, high blood pressure, cigarette smoking (a concern for teens, of course), low HDL (“good” cholesterol), a history of Kawasaki disease, kidney disease, is an organ transplant recipient, or has conditions like juvenile rheumatoid arthritis, lupus, or HIV.
- LDL higher than 100 mg/dL, if:
- Your child has Type 1 or Type 2 diabetes.
- Your child has had Kawasaki disease that caused enlarged heart arteries (aneurysms).
What Kind of Medications Are We Talking About?
For kids with high LDL levels, statins are often our first go-to medical treatment. You might have heard of some of them, like atorvastatin (Lipitor®), rosuvastatin (Crestor®), or simvastatin (Zocor®).
These medications work by:
- Telling the liver to make less cholesterol.
- Helping the body pull extra cholesterol out of the blood so it can be processed properly.
Ezetimibe is another option, often considered a second-line medication. It works differently, by blocking cholesterol absorption in your child’s gut, so less of it gets into the bloodstream.
Dealing with High Lipoprotein (a)
Remember Lp(a)? Lifestyle changes don’t move the needle as much for this one, unfortunately. And right now, we don’t have specific medications approved to treat high Lp(a), though research is very active in this area. So, if your child’s Lp(a) is high, our focus will be on aggressively managing all other heart disease risk factors: heart-healthy eating, plenty of exercise, treating other cholesterol issues with medication if needed, and absolutely avoiding smoking.
Tackling High Triglycerides
For high triglycerides, we’ll often recommend:
- Those important changes to diet and physical activity.
- Sometimes, fish oil supplements (we might go up to 4,000 mg per day under guidance).
- In select cases, especially with severely high triglyceride levels, other medications might be considered.
We’ll figure out the best path for your child together, always.
Can We Turn This Around?
Yes, absolutely! That’s the most important message. Treatment, whether it’s lifestyle changes alone or with medication, can help lower your child’s cholesterol to safer levels. And by doing that, we significantly lower their risk of serious heart-related complications as they grow older. We’ll work with you to set clear, achievable goals for your child’s cholesterol and map out how to reach them.
Your Role: Teaming Up for a Healthy Heart
You’re a superhero in this story, truly. As a parent, the everyday choices you help your child make can have a huge impact. Here’s how you can help lower your child’s cholesterol:
- Eat foods low in total fat: The goal is for total fat to be 30% or less of their daily total calories. A dietitian can be a fantastic partner in figuring this out and creating kid-friendly meal plans.
- Ditch trans fats, limit saturated fats: Saturated fat is usually solid at room temperature (think animal fats, coconut oil, palm oil). This should be less than 10% of total calories. Instead, choose unsaturated fats like those in olive oil, avocados, and flaxseed oil.
- Watch dietary cholesterol consumption: Aim for less than 300 mg of cholesterol per day.
- Smart dairy choices: For little ones 12 to 24 months old, 2% milk is fine. After 24 months, we generally recommend fat-free milk.
- Fiber is your friend: Encourage lots of foods high in dietary fiber – vegetables, fruits, legumes (beans and lentils), seeds, and whole grains.
- Get moving! Regular aerobic activities like biking, running, brisk walking, and swimming can help raise those “good” HDL levels and lower overall cardiovascular risk.
- Maintain a weight that’s healthy for them: We can help you figure out what that healthy range is for your child’s age and height.
Making Meals Heart-Healthy and Kid-Friendly
Think variety, think color! It doesn’t have to be boring.
- Breakfast: Fruit, whole-grain cereal, oatmeal, Greek yogurt.
- Lunch and dinner: Try using the USDA MyPlate model. Fill half their plate with fruits and vegetables, a quarter with lean protein (like chicken, fish, or beans), and a quarter with whole grains. Add a serving of low-fat dairy on the side.
- Healthier cooking methods: Baking, broiling, grilling, and air frying are great. Try to steer clear of deep frying most of the time.
- Snacks: Fruits, vegetables with dip, nuts and seeds (if age-appropriate), whole-grain crackers, low-fat yogurt or cheese.
- Beverages: Water and low-fat milk are the best choices. Sugary drinks like soda, sweetened milk, most juices, and sports drinks? It’s best to limit those as much as possible.
Keeping Tabs: When to See Us
We’ll set up a schedule for follow-up appointments. Your child will likely need blood tests on a regular basis to monitor their cholesterol levels. We usually recheck levels after about six months of dietary changes and/or after about two months of starting or changing a medication.
Take-Home Message: Key Things to Remember About High Cholesterol in Children
Here are a few key points I hope you’ll take away:
- High cholesterol in children is often a “silent” condition, but it’s easily detectable with a simple blood test.
- Family history and genetics play a significant role, alongside lifestyle factors like diet and exercise.
- Early detection and management are crucial. Starting with diet and exercise can make a big difference in protecting your child’s future heart health.
- When needed, medications are available, safe, and effective for children.
- You’re not alone in this. We, your healthcare team, are here to support your family every step of the way.
It can feel overwhelming, I know. That initial news can be a shock. But remember, identifying this early is a huge, positive step. We’re in this together to help your child grow up strong and healthy, with a happy heart.