Clinical Reference Systems: Pediatric Advisor 10.0

THE IMPORTANCE OF TREATMENT

If your child's cholesterol level is high or borderline high, start this treatment program. If your child's cholesterol level is normal, it is still a good idea for your whole family to follow these recommendations.

High cholesterol is not the only risk factor for coronary heart disease. Other risk factors are just as harmful: physical inactivity, obesity, and smoking. The more risk factors that you or your child has, the higher the risk of heart disease. Living a long and healthy life requires healthy eating and regular exercise. It is easier to start these habits as a child than to have to adopt them as an adult.

Discuss the following ways to reduce cholesterol levels with your family and try them. If you follow most of these recommendations, you are protecting your child's heart and blood vessels.

TREATMENT RECOMMENDATIONS

1. Low-Fat Diet

   The American Heart Association recommends a low-cholesterol, low saturated-fat diet for all children over age 2 years. (None of the following recommendations apply to children younger than 2).

   Eating foods that contain cholesterol raises our blood cholesterol levels. Foods that come from plants, such as fruits, vegetables, and grains, do not contain cholesterol. Foods that come from animals, such as meats, eggs, and milk products, do contain cholesterol.

   Eating saturated fats also raises blood cholesterol levels because fat causes our bodies to make more cholesterol. Even if we don't eat any fat, the liver produces a small amount of cholesterol each day. Therefore, we will always have some cholesterol in our blood.

   Currently, most Americans get 40 percent of their daily calories from fat. However, in a healthy diet no more than 30 percent of the total calories should come from fat. The goal is to eat fat in moderation. You do not have to eliminate fat from your child's diet entirely. Lower the amount of fat your child eats so that fat provides no more than 30 percent of your child's daily calories.

   Serving your family a low-fat diet will help lower everyone's cholesterol levels and is rather easy:

   • Serve more fish, turkey, and chicken because these meats have less fat than red meats. Buy lean ground beef or ground turkey for hamburgers. Use lean ham or turkey for sandwiches.
   • Trim the fat from meat and remove the skin from poultry before you eat it.
   • Avoid the meats with the highest fat content, such as bacon, sausages, salami, pepperoni, and hot dogs.
   • Limit the number of eggs each person eats to 3 or 4 eggs a week.
   • Limit all meats to moderately sized portions.
   • Use 1-percent or skim (0.5-percent) milk instead of whole milk (which is 3.5 percent fat).
   • Use soft margarine products and vegetable oils instead of butter.
   • Avoid any food fried in butter or fat. If you prefer to fry meats, use margarine or nonstick cooking sprays.
   • Increase the amount of fiber your child eats. Most grains, vegetables, and fruits are good sources of fiber.

2. Family Exercise Program

   Exercise is the best way to raise the level of HDL (the "good" cholesterol) in your blood. Your goal should be 20 to 30 minutes of vigorous (aerobic) exercise three times each week. For exercise to be vigorous it must involve the large muscles of the legs and cause your heart to beat faster. Vigorous exercise also improves your heart's response to work. A child is much more likely to exercise if you exercise with him.

   Try the following forms of exercise:

   • Walk or bike instead of riding in a car.
   • Use stairs instead of elevators.
   • Take the dog for a walk, jump rope, or play ball if your child appears to be bored.
   • Encourage your child to join a team (for example, soccer) or learn a new sport (for example, roller skating) that requires vigorous exercise. Swimming and jogging are sports that burn lots of calories. Some sports, such as baseball and football, don't exercise the heart.
   • Exercise to a video tape or music on TV.
   • Use an exercise bike, dance, or run in place while you or your child watches TV.

     In addition, limit TV and video game time to 2 hours or less a day. These sitting activities interfere with physical fitness. And support better physical education programs and aerobics classes in your schools.

3. Ideal Body Weight

   Children who are overweight tend to have a low HDL and a high LDL, which is the opposite of what is good for them. Helping your child return to ideal body weight will improve his blood cholesterol levels.

   Fat has twice as much calories as the same amount of protein or carbohydrates. When a person eats less fat each day, he automatically gets less calories from his food each day. A low-fat diet AND exercise are the key ingredients for losing weight.

   If your child is overweight, see also

   Overweight: A Weight Reduction Program

4. Smoke-Free Home

   If you are a smoker, a good way to raise your own HDL level is to stop smoking. Also avoid exposing your child to smoke.

   If someone in your home is a smoker, see Passive Smoking.

5. Good Examples

   A child who must lower his cholesterol level needs help from his family. If you put him on a special diet, put the entire family on the special diet. If you put him on a special exercise program, make sure that other family members participate. Eat healthy foods and snacks, so your child will eat healthy food. Play more sports and watch less TV sports, as you would like your child to do.

   If your child's level of cholesterol remains high even though you follow these treatment recommendations, ask for a consultation with a nutritionist about special diets. Also, have your child join an exercise program at a local gym or fitness center. These additional steps will usually help your child. Medications are sometimes prescribed for adults to help lower their cholesterol levels. However, they are rarely prescribed for children unless they have a rare form of high cholesterol related to disease rather than diet.

RECHECKING YOUR CHILD'S CHOLESTEROL LEVEL

Generally, if your child has high cholesterol (above the 95th percentile), his cholesterol level is checked again about 2 to 4 months after he starts a program to lower it. If the cholesterol level is borderline high (above the 75th percentile), it is usually checked yearly.