Many of us think of adults when we think of heart health and the prevention of heart disease, which is why some parents are surprised when they are asked by a physician about a cholesterol screening for children. The National Heart, Lung, and Blood Institute has recommended screening for cholesterol in children between the ages of 9-11 and then again at ages 17-19. This recommendation is supported by the American Academy of Pediatrics. The reason it is not optimal to complete a cholesterol screening between the ages of 12-16 is because cholesterol levels will naturally lower due to hormonal changes during these years.
Some children may be tested earlier if they are high risk. The factors that would make a child high risk may include:
- A first degree relative with history of dyslipidemia with a total cholesterol of greater than 240 mg/dl.
- Strong family history of early cardiovascular disease, such as stroke or heart attack at a young age, which is before 55 for men and before 65 for women.
- A child that has diabetes, hypertension, and/or a BMI >85th percentile
The lab value that is used to determine if cholesterol in children is concerning is not always the total cholesterol, but the non-High-Density Lipoprotein Cholesterol (non-HDL). The non-HDL cholesterol represents the amount of different types of cholesterol that can lead to the hardening or narrowing of the arteries that occurs in heart disease. The non-HDL cholesterol is calculated after a cholesterol panel is obtained through a non-fasting in-office finger stick. The HDL cholesterol value is subtracted from the total cholesterol. You can talk to your child’s physician about desired levels.
There are many healthy habits a family can encourage no matter what your child’s cholesterol level to help with prevention of heart disease. They can include the following actions:
- Encourage them to eat more fish or other foods that contain omega 3 fatty acids, which are thought to be beneficial for heart health. These foods can include salmon, walnuts, and chia seeds.
- Increase physical activity and decrease their screen time. The goal is for children to get about 60 minutes of physical activity per day. This does not have to be all at one time. It can be split up through the day. It is recommended that screen time be limited to 2 hours per day and not replace activity or sleep.
- Limit the sources of saturated fat in your child’s diet. The biggest contributors of saturated fat typically come from animal fats and baked goods and snack foods like chips, cookies, and candy. It may be good to have a discussion with your child about how much of these foods is reasonable to have in a day. For example, if they really want a cookie after school, that is fine. However, remind them that the next snack should be something like a fruit or a vegetable.
- Decrease added sugars in the diet. Fruit juices, sodas, fruit drinks, fruit snacks, and other food items that are marketed toward children can increase the added sugar in your child’s diet. Added sugar refers to what is added to the food in its raw form. Therefore, the concern is not as much over the sugars that occur naturally in foods like fruit, starchy vegetables, milk, grains, or plain yogurt, but about the amount of sugar added. A good recommendation is to choose products with no more than 10 grams of added sugar.
- Increase your kid’s fiber intake by encouraging whole grains. Some foods that are considered whole grains are brown rice, oatmeal, whole wheat bread, and quinoa. For a product to be considered a good source of whole grains, the first ingredient needs to be the whole grains.
- Increase fruits and vegetables in your family’s diet. The minimum goal is 5 servings per day. This can be accomplished by serving fruit with breakfast, a fruit and a vegetable with lunch, and a fruit and vegetable with dinner to get your minimum of 5 servings per day.
- Include more plant-based proteins at their meals. Meat does not always have to be the center of the meal. There are many beans and legume that can make tasty meals. Plant-based proteins contain fiber, which is filling and lower in fat – a good thing for heart health. Including these items in family meals on a regular basis will help make it a habit in their life for years to come.
A cholesterol screening should not be scary for the parent or the child. It is preventative care just like going to the dentist. The above recommendations are good for the entire family. Choose a few you think you may enjoy implementing for your family!