Clinical Reference Systems: Pediatric Advisor 10.0
Cholesterol Screening or Testing
THE IMPORTANCE OF LOW CHOLESTEROL
Everyone needs to have some cholesterol in their blood.
Cholesterol is the normal way fat is carried in the
bloodstream. However, people who have higher than normal
levels of cholesterol have a greater risk of developing
coronary heart disease (CHD). If they lower their
cholesterol levels, they reduce their chances of having
heart disease. A 1-percent decrease in blood cholesterol
leads to a 2-percent decrease in the risk of CHD in adults.
One major goal of preventive medicine is to lower high
cholesterol levels to healthy levels.
The amount of cholesterol and saturated fats we eat affects
the level of cholesterol in our blood. If we eat less
cholesterol and saturated fat, we will have less cholesterol
in our blood.
Many children and adolescents who have high cholesterol
continue to have high cholesterol when they are adults.
Children who reduce their cholesterol levels with proper
diet and exercise may have a better chance of having low
cholesterol when they are adults.
TYPES OF CHOLESTEROL
Cholesterol has several components: high-density
lipoproteins (HDL), low-density lipoproteins (LDL), and
triglycerides. All of these components combined are called
"total cholesterol." The HDL component is called the "good"
cholesterol because it carries cholesterol away from the
arteries to the liver. The liver helps the body get rid of
cholesterol. LDL is called the "bad cholesterol." If you
have too much LDL, the LDL leaves cholesterol on the inner
walls of the arteries. As a result your arteries become
So, in addition to reducing total cholesterol levels, it is
helpful to increase the HDL and decrease the LDL in the
blood. A 1-percent rise in HDL may give adults a 3-percent
decrease in the risk of coronary heart disease.
NORMAL AND ABNORMAL CHOLESTEROL LEVELS
Normal levels of total cholesterol in children are between
120 and 170 mg/dl. After age 18, the levels considered to
be normal rise about 1 point per year of age. A healthy
level of total cholesterol is below the 75th percentile.
For children this means a cholesterol level below 170 mg/dl.
(The level of cholesterol in adults should be below
200 mg/dl.) Levels between the 75th and 95th percentiles
are considered to be borderline high. Levels above the 95th
percentile (higher than 200 mg/dl in children and 240 mg/dl
in adults) are high and abnormal. In general, anyone who
has a total cholesterol above the 75th percentile should try
to lower it.
Levels of HDL, which we want to be high, should be above the
25th percentile (over 45 mg/dl in children and over 40 mg/dl
in adults). A borderline low value is between the 5th and
25th percentiles. A low or abnormal value is below the 5th
percentile (less than 35 mg/dl in children, 30 mg/dl in
TESTING THE CHOLESTEROL LEVELS IN CHILDREN
The American Academy of Pediatrics and the American Heart
Association agree that all children who are at high risk for
coronary heart disease should be screened soon after they
are 2 years old.
The normal diet of children younger than 2 years is high in
fat, and therefore high in cholesterol, because they are
growing so fast. It is not appropriate to test children
younger than 2 years.
A child is at high risk of developing CHD as an adult if
members of the family have had high blood cholesterol or
early coronary heart disease. Family members include
parents, grandparents, aunts, or uncles. A history of early
coronary heart disease includes heart attack, angina,
stroke, or bypass surgery that occurs in men less than 50
years old or women less than 60 years old. The information
about grandparents is important because other relatives
might not yet be old enough to have developed heart disease.
Over half of the children who have high cholesterol levels
are found by testing children with these high risk factors.
Doctors do not agree on when to check the cholesterol levels
of children who are not high risk. The main reason for
testing everyone is to identify all children with high
cholesterol. Eating and exercise habits that lower
cholesterol levels need to be started early. The main
arguments against testing all children are that it is
costly, high cholesterol levels do not persist into
adulthood half the time, and healthy diets can be started
for all children without knowing their cholesterol levels.
If a doctor or clinic does check the cholesterol levels of
all children, they usually check children between 2 and 5
years old, often when they start kindergarten.
RETESTING CHILDREN WITH HIGH CHOLESTEROL LEVELS
If your child's cholesterol is borderline high or high, it
will be checked again 1 to 2 weeks after the first test.
Cholesterol levels do vary somewhat day to day, so it is
important to confirm that the cholesterol is high.
Children with confirmed high total cholesterol (greater than
the 95th percentile) will then have blood drawn for a lipid
profile or panel. This test measures the levels of LDL,
HDL, and triglycerides, as well as total cholesterol.
Treatment will start and the level of cholesterol will be
checked again in about 2 to 4 months.
If your child has a total cholesterol level that is
borderline high (between the 75th and 95th percentiles),
treatment can start without the lipid panel. Your child's
total cholesterol will probably be rechecked every year.
Lipid panels are not done for all children because they cost
much more than the total cholesterol test. In addition, the
lipid panel requires blood drawn from a vein. This can be a
more difficult procedure for a child than pricking a finger.
RETESTING CHILDREN AND ADULTS WITH NORMAL CHOLESTEROL LEVELS
Children with total cholesterol below the 75th percentile do
not need their cholesterol checked again until they become
adolescents. Most physicians check the total cholesterol
level of adults every 5 years as long as it remains in the
TESTING FAMILY MEMBERS
If your child has high cholesterol (higher than 95th
percentile), everyone in your family should have their total
cholesterol checked. Very often the close relatives of
children with high cholesterol also have high cholesterol.
Discovering that other family members have high cholesterol
will further encourage you to start your family on a
healthier diet and exercise program.
For information on the treatment of high cholesterol, see
Treating High Cholesterol Levels.