There are many challenges in determining who should be screened for cholesterol and when. Screening is usually done through a blood test called a lipid panel. There are new concerns for kids who have metabolic syndrome and insulin resistance, as these problems in adolescence and childhood predict metabolic syndrome in adulthood.
The National Heart, Lung and Blood Institute (NHLBI) published a new recommendation in 2012 for universal screening of all children 9 to 11 years of age with a non-fasting lipid panel, and targeted screening with two fasting lipid profiles of kids ages 2 to 8 years and 12 to 16 years. The American Academy of Pediatrics (AAP) endorsed this recommendation. Previous guidelines suggested screening only high-risk children.
There is much debate over this recommendation, and many health care providers continue to recommend a more narrow screening based on family history of cholesterol problems. The NHLBI panel’s position is that the problems of high cholesterol, such as atherosclerosis, begin in childhood and are a lifelong process. Early identification can lead to beneficial diet and lifestyle changes. The panel also recommends screening before age nine for children who have diabetes or a family history of cholesterol problems. The other part of the controversy is what to do when a lab test is abnormal for a child with neither physical problems nor a family history of them.
Some members of the AAP have recommended these questions be part of a conversation for all parents, with monitoring for weight problems, blood pressure and lifestyle an important part of that conversation. The AAP also recommends limiting sedentary screen time to two hours or less per day and to have all kids get at least one hour of moderate physical activity daily. These recommendations are meant to decrease obesity and get families involved in physical activity.
The recommendation for low-density lipoprotein (LDL) cholesterol in milligrams per deciliter is: 130 mg/dl, acceptable; 110-129 mg/dl, borderline high; and >130 mg/dl,high. The NHLBI guidelines state that no cholesterol-lowering medicines should be considered until a minimum six-month trial of lifestyle changes fails to lower very high (>190 mg/ dl) cholesterol in children age ten or older. Testing will also help identify the small number of kids who have a genetic disorder called familial hypercholesterolemia.
It is always good to know about your family’s health. Learning about your family history and the health problems that adults in your family face can help you and your children become aware of potential health issues. Screening for kids 9 to 11 years of age may give your family the information needed to benefit from coaching and counseling early in life, rather than being treated for cardiovascular disease later on.
Terea Giannetta, DNP, RN, CPNP, is a certified PNP and Chief PNP at Children’s Hospital Central California, where she has had a clinical practice in Hematology/ Oncology ambulatory clinic for the past 20 years. She is also a full-time faculty member and Associate Professor at California State University, Fresno.