First, repeat the test to be sure it's really a problem...

Then, reduce fat in the diet...

Teach the child lifestyle risk reduction strategies...

Finally, be followed by a specialist.

REPEAT THE TEST: An elevated "random" or "screening" cholesterol in children is considered to be anything >205. However, the screening result could be falsely elevated if the child consumed high-fat foods in the 12-24 hours before the blood sample was obtained, AND, even if truly elevated, this might not be a medical problem if the balance between LDL ("bad") and HDL ("good") cholesterol (not measured in the initial screening) turns out to be favorable.

Because of the above, when the screening test is elevated we recommend a second test drawn in a "fasting" state - first thing in the morning when he/she has had nothing but water for at least 12 hours, basically since after dinner the night before. This test is also more detailed, breaking the cholesterol down into LDL vs. HDL, measuring other fats, and calculating a "cardiac risk index" (CRI) for atherosclerosis. A risk index of 1.0 means the person is average risk compared to other members of the population; 0.5 means half as likely to get atherosclerosis; 2.0 means twice as likely, etc. Usually we only worry about or treat children whose CRI's are 1.4 or greater. Only about half of the children with an elevated initial screen will turn out to be in that category.

CHANGE THE LIFESTYLE: When the cholesterol is truly a problem, it is important to remember this is a very long-term issue and poses no immediate threat. At worst, the child may be at increased risk of developing atherosclerosis and it’s complications (early heart disease, stroke) in middle-to-late adulthood, and should thus takes steps throughout his or her life to reduce that risk. The reason we screen at this age is mostly so that the child can grow up knowing this is something they need to be aware of. MANY other factors affect the risk of atherosclerosis beyond just cholesterol - including physical fitness, weight, family medical history, smoking, and other lifestyle issues all of which a child with high cholesterol should be made more aware of.

ALTER THE DIET: Our usual recommendation for children with elevated CRI is to reduce the amount of fat and cholesterol in the diet (see our "Heart Healthy Diet" tips). This will reduce both the total cholesterol and the "risk index" only about half of the time. We also often refer such children to the "Preventive Cardiology Clinic" at Children’s Hospital for further evaluation and counseling. However, children are RARELY treated with the cholesterol-lowering drugs commonly used nowadays in adults. Such medicines have not yet been FDA approved in children and are available to them on a research basis only. To be a candidate a child usually needs to have a VERY high cholesterol (>400) and a very strong family history of early atherosclerosis. It may be advisable, on the other hand, for children with elevated cholesterol or CRI to take a multivitamin daily. (This is one of the few exceptions to our general feeling that most children don't need extra vitamins, and stems from research in adults showing that certain vitamins may actually slow the development of atherosclerosis.)