Children should be checked for blood cholesterol levels between 9 and 11, and then again between 17 and 21 years, the National Institutes of Health (NIH) has announced in new guidelines for doctors. The NIH says the guidelines have been endorsed by the American Academy of Pediatrics. In other words, two cholesterol checks before the age of 21. The guidelines have been published today in the journal Pediatrics.

The new recommendations appear in a document titled “Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report”.

Previous recommendations included only children with a family history of high cholesterol or heart disease, and other factors linked to cardiovascular disease risk.

The authors wrote:

“Atherosclerosis begins in youth, and this process, from its earliest phases, is related to the presence and intensity of the known cardiovascular risk factors. Clinical events such as myocardial infarction, stroke, peripheral arterial disease, and ruptured aortic aneurysm are the culmination of the lifelong vascular process of atherosclerosis.”

They add that the earlier cardiovascular prevention starts the better.

As parents of young children are generally young too, they may not have manifested any of the signs and symptoms indicating a family history of cardiovascular problems. The authors say doctors should include grandparents, aunts and uncles when deciding on whether family history is a risk factor for a pediatric patient.

If a family history does exist of cardiovascular disease, doctors should screen for various risk factors. Otherwise, only routine non-HDL cholesterol screening should be done. Non-HDL cholesterol screening does not require the patient to fast beforehand, so it can be done there and then during the child’s visit to the doctor.

A child with high cholesterol should initially be treated with a change in diet, the authors wrote. Drugs should only be considered if the LDL levels reach 190 mg/dL for patients aged 10 years or more, and for whom diet and physical activity interventions were not effective.

If risk factors are present, the LDL threshold is lowered to 160 mg/dL.

The guidance also recommends:

  • Parents should start talking to their children about the harms of tobacco products when they are between 5 and 9 years of age
  • Parents should make sure their children are not inhaling environmental tobacco smoke
  • Health professionals should monitor children’s height-weight ratios together with their partents. If after the age of 4 they remain above the 85th percentile with no weight loss after six months, they should be referred to a qualified dietitian
  • Children should have their blood pressure checked once a year from the age of 3 years
  • Children should be encouraged to be physically active and limit the amount of time they remain sitting in front of screens. Sedentary pastimes should be limited to no more than two hours per day
  • Fasting glucose should be monitored from the age of 9 to 11 years

The guidelines advice doctors to use proper terms with their real meanings when describing a child’s current state. For example, if the child’s BMI is in the 85th to 95th percentile they should say they are overweight, rather than at risk of overweight, and those in the 95th percentile or above should be called obese, rather than overweight, regardless of how young the child is.

Reactions to these guidelines have been mixed, from enthusiasm to skepticism and serious concern. A predominant feedback we have received at Medical News Today has been that higher cholesterol levels during childhood do not necessarily lead to heart disease later on.


Over the last few decades, obesity/overweight rates among children in the USA have risen alarmingly. From 2000 to 2006 increase in prevalence of obesity slowed down considerably to just over 17%. By 2008, it was estimated that 32% of American children were overweight or obese. (The graph above refers only to obesity, not overweight)

A recent study published by the UCLA Center for Health Policy Research and the California Center for Public Health Advocacy (CCPHA) reported that the obesity/overweight rate in Californian children dropped one percentage point from 2005 to 2010. (Link to article)

A recent study carried out by the University of Bristol, England, found that UK GPs (general practitioners, primary care physicians) are reluctant to talk about obesity or overweight with parents, or refer their overweight children to weight reduction services. The researchers informed that with 1 in 5 children aged 11 years being currently overweight or obese in the UK, it is vital that GPs make an effort to address this growing problem. (Link to article)

Other studies in several countries around the world have revealed a similar problem regarding doctors’ reluctance to talk about obesity/overweight with children or their parents.

Written by Christian Nordqvist