So what is cholesterol? Cholesterol is a chemical substance found naturally in the human body, plants, and animal products. In fact, your body makes most of its own cholesterol in the liver. Cholesterol is a necessary substance to help the body make hormones and cell walls. However, when it builds up or is in excess in the blood stream it can block arteries. This process is called atherosclerosis. If the blockage is severe or occurs in vital arteries it can cause a stroke or heart attack. Cholesterol is carried in the blood by fat-protein complexes called lipoproteins. There are 2 types, low-density lipoproteins (LDL) and high-density lipoproteins (HDL). LDL are the major carries of cholesterol in the blood. High levels of LDL are harmful since this cholesterol builds up causing the artery to block. HDL are the good guys! They work by carrying cholesterol away from arteries and helping the body remove excess. HDL can be increased by exercise and physical activity.

Though studies have linked cholesterol levels in childhood to adult coronary artery disease, there is still controversy regarding universal screening of children. The American Academy of Pediatrics has adopted a position against universal screening. Instead, it recommends testing only children with a strong family history of high cholesterol or early heart disease. The problem with this is that many studies have shown limiting screening to these criteria will miss more than half the children with elevated cholesterol, and other studies have demonstrated the presence of early atherosclerotic changes in the arteries of children & teenagers with a correlation between the severity of these changes and cholesterol levels. Based on these studies, many pediatricians have decided to screen all children, although there is no universally agreed-upon schedule for this. Our policy at this office is to do this at least once during the preschool years, once during elementary school, and at once during adolescence. We screen more frequently (every three years) when there is a strong family history of atherosclerotic disease. A level below 205 is not concerning.

Cholesterol level in the blood is determined by both diet and genetics. Since you can't change your genetic heritage, the way to reduce your blood cholesterol is to change your diet. The traditional American diet is high in fat, salt, and cholesterol. In fact, most Americans get 40-50% of all calories from fat. This is too much. Experts feel that we should ALL reduce our fat intake to 30% of all calories. Daily intake of cholesterol should be no more than 300mg. The only way to do this is to decrease fatty foods in the diet and choose foods that are lower in cholesterol. Fat in foods is divided into saturated (hard at room temperature like butter) and unsaturated (soft-liquid at room temperature). Saturated fat comes from animal products and should be avoided. Unsaturated fat is found in vegetable products and is cholesterol free. The goal in reducing fat and cholesterol is a "heart healthy diet" (see reverse). Restrictions of diet should never be attempted on children under 2 years of age, however, or in children who are underweight. Infants and toddlers need fat in their diet to help them grow. It is also important not to severely restrict your child's diet at any age. The recommendations given are a guide to healthy eating, not a prescription to drastically change your child's intake.

If the total cholesterol level is elevated there are two options regarding the next step. One option is to repeat the level with a fasting lipid profile immediately. Getting a fasting level is important since recent intake of high fat foods can cause a falsely elevated cholesterol level. A lipid profile examines relative levels of HDL, LDL and other fats to give a more complete picture of the risk of development of early heart disease. This generates a "cardiac risk index" for heart disease, which compares a particular patient to the rest of the American population. A risk level more than 1.4 times average is cause for concern. This would necessitate a low cholesterol diet and more frequent monitoring of cholesterol levels. The second alternative entails initiating a low cholesterol diet right away based on just the total cholesterol level. In 6-12 months a lipid profile would be done. The advantage to this approach is it saves the child a needle stick - the drawback is uncertainty about the reason for improvement (if there is some) on the next test - whether it's because of the diet or whether the initial screen was a "false alarm". For more about this please see: "WHAT IF MY CHILD'S CHOLESTEROL IS HIGH?"

Remember that along with a proper diet comes exercise. Encourage your child to get outside, participate in sports, and have some chance for daily activity. Finally, parents should also follow a heart healthy diet. It sets a good example, and it's better for you as well.