High Cholesterol in Children

What is high cholesterol in children?

High cholesterol in children (sometimes called pediatric high cholesterol) is when your child’s cholesterol levels are higher than they should be. It’s also possible for kids and teens to have high triglyceride levels. Cholesterol and triglycerides are fats (lipids) that circulate in our blood. We need some lipids to support our bodies’ needs, but higher-than-normal levels can lead to health problems.

So, how do you know if your child has high cholesterol or high triglycerides? Providers do a blood test called a lipid panel to check lipid levels. What’s normal or not varies by age. For example, normal cholesterol levels in adults are slightly different from normal pediatric levels.

The chart below lists normal, borderline and abnormal lipid levels for children. Note that HDL cholesterol (“good cholesterol”) is the only number that’s abnormal when it’s too low.

What are the symptoms of pediatric high cholesterol?

Your child typically won’t have any obvious symptoms of high cholesterol. But severely high cholesterol levels, especially high levels from genetic causes, may lead your child to develop:

• Waxy, fatty plaques on their skin (xanthoma)
• Yellow bump on or near their eyelid (xanthelasma)
• White or grayish rings around the outer edges of their eyes (corneal arcus)

Why would a child’s cholesterol be high?

Many factors affect your child’s cholesterol levels, including:

• What they eat
• How much physical activity they get
• Medical conditions they have, like obesity, diabetes and nephrotic syndrome
• Medications they take
• Genes they inherited

Kids with high cholesterol commonly have a biological parent with a history of elevated cholesterol or a biological parent who needs medications to keep their cholesterol at a safe level.

Genetic causes of high cholesterol in children

Genetics play a big role in causing pediatric high cholesterol. Let’s take a closer look at how it works.

Familial hypercholesterolemia in kids

A genetic condition called familial hypercholesterolemia (FH) causes children to have high LDL cholesterol (“bad cholesterol”) from birth. This is most commonly a dominant condition, meaning that it only takes one abnormal gene from one parent to pass it on to a child.

Your child’s provider may suspect this condition if your child’s LDL level is 160 mg/dL or higher without other known causes. In children whose parents have FH, even LDL cholesterol levels that are above 130 mg/dL are concerning.

Polygenetic causes

FH isn’t the only genetic cause of high cholesterol in kids. If your child’s high cholesterol has polygenetic causes, that means they inherited multiple genes from both parents that cause them to have high LDL. Their LDL level may rise over time but not be very elevated until their late teen years or early adulthood. 

These genetic factors can lead to increased cardiovascular risk, but the risk is less severe than having FH early in life. Kids with FH typically need medications sooner than kids with polygenetic causes.

Lipoprotein (a)

Lipoprotein (a) (pronounced “lipoprotein little a”) is a specific kind of cholesterol that parents can pass down to their kids. Higher levels of lipoprotein (a) raise a person’s risk of coronary artery disease and can be associated with rare cases of stroke in childhood.

Your child’s provider may recommend a blood test to check their lipoprotein (a) levels if they have one or more of the following risk factors:

• A familial hypercholesterolemia diagnosis
• A history of an ischemic stroke without a known cause
• A biological parent with high lipoprotein (a) levels
• A biological first-degree relative (parent or sibling) who had an early heart attack

Why would a child’s triglycerides be high?

Common causes of high triglycerides in children include:

• Obesity
• Diabetes
• Certain medications

There are also genetic causes of high triglycerides, but this is less common than with FH. If your child has a fasting triglyceride level of 500 mg/dL or higher, without other causes, then providers may consider a genetic cause.

What are the possible complications of high cholesterol in children?

Children who have high cholesterol (LDL cholesterol) may develop health concerns as they get older. These include issues with plaque (atheroma) buildup blocking blood flow to their heart, brain or legs. You might know these conditions as:

• Heart attack
• Stroke
• Peripheral artery disease

What are the possible complications of high triglycerides in children?

High triglyceride levels can lead to inflammation of your child’s pancreas (pancreatitis). Over long periods, high triglycerides may contribute slightly to plaque formation in your child’s arteries, but it plays far less of a role than LDL cholesterol.

How do providers diagnose high cholesterol in children?

Healthcare providers can check cholesterol in school-aged children with a simple blood test. In certain situations, your child should fast (nothing to eat or drink for at least 12 hours) before getting the labs drawn. Be sure to ask your provider if this is necessary.

Doing such a test is especially important if there’s a strong biological family history of heart disease or if a parent has high cholesterol. The blood test results will show if your child’s cholesterol or triglyceride levels are too high.

How is high cholesterol in children treated?

The first step in managing high cholesterol is making changes to what your child eats and the amount of physical activity they get. Your child’s provider will advise you on what to do. If these changes aren’t enough to lower your child’s cholesterol to safe levels, their provider may recommend medication (for kids age 8 and older).

Does my child need medication?

Possibly. Providers follow the expert guidance of the National Heart, Lung and Blood Institute and the American Heart Association in deciding when to recommend medication. Here are the situations when providers may recommend medication for your child.

LDL higher than 190 mg/dL, if:

• Your child has no other risk factors for cardiovascular disease

LDL 160 mg/dL or higher, if at least one of the following is true:

• Your child has risk factors for cardiovascular disease
• One parent has a history of early heart attack or plaque in the heart arteries (coronary artery plaque)
• Changes to foods and physical activity haven’t brought their cholesterol to target levels after six months

LDL higher than 130 mg/dL, if at least one of the following is true:

• One parent has been diagnosed with FH
• Your child has cardiovascular disease risk factors like obesity, high blood pressure, cigarette smoking, low HDL, history of Kawasaki disease, kidney disease, solid organ transplant, juvenile rheumatoid arthritis, lupus or HIV

LDL higher than 100 mg/dL, if at least one of the following is true:

• Your child has type I or type II diabetes
• Your child has Kawasaki disease that caused enlarged coronary arteries (aneurysms)

Which medications do providers use to treat high cholesterol in children?

For kids with elevated LDL levels, statins are the first-choice medical treatment. These include medications like:

• Atorvastatin (Lipitor®).
• Rosuvastatin (Crestor®).
• Simvastatin (Zocor®).

Statins lower your child’s LDL by:

• Stopping their liver from making cholesterol
• Helping their body pull excess cholesterol out of their blood so their body can properly use it

Ezetimibe is the second-line medication to lower LDL levels. It works by blocking the absorption of cholesterol in your child’s gut so it can’t reach their bloodstream.

Treating high lipoprotein (a)

Lifestyle doesn’t affect lipoprotein (a) levels as much as it does LDL levels. Currently, there aren’t any medications that specifically treat elevated lipoprotein (a). But medication trials are underway. If your child’s lipoprotein (a) levels are high, their provider may recommend focusing on reducing their other risk factors for coronary artery disease by:

• Eating heart-healthy foods
• Getting enough physical activity
• Treating other cholesterol levels with medication
• Avoiding smoking

Treating high triglycerides

Your child’s provider may recommend:

• Changes to your child’s foods and physical activity
• Fish oil supplements (up to 4,000 mg per day)
• Other medications (in select cases to treat severely high triglyceride levels in children)

Can high cholesterol in kids be reversed?

Yes. Treatment can help lower your child’s cholesterol to safer levels, in turn lowering their risk of serious complications down the road. Your child’s provider can give you the most accurate sense of what your child’s target cholesterol levels should be and how to get there.

How can I help lower my child’s cholesterol?

You can help lower your child’s cholesterol levels by encouraging them to do the following:

• Eat foods low in total fat. The total amount of fat your child consumes should be 30% of their daily total calories or less. A dietitian can help you calculate this number and create meal plans.
• Avoid trans fats and limit saturated fats. Saturated fat is usually solid at room temperature and comes from animal fats, coconut oil and palm oil. Saturated fat should be less than 10% of total calories. Instead, choose unsaturated fats like olive, avocado and flaxseed oils.
• Limit dietary cholesterol consumption. Your child should consume less than 300 mg of cholesterol per day.
• Avoid full-fat dairy. Kids 12 to 24 months old should consume 2% milk. Kids over 24 months should consume fat-free milk.
• Eat enough fiber. Encourage high dietary fiber intake. Foods high in fiber include vegetables, fruits, legumes, seeds and whole grains.
• Get regular physical activity. Regular aerobic activities — like biking, running, walking and swimming — can help raise HDL levels and lower your child’s risk for cardiovascular disease.
• Maintain a weight that’s healthy for them. Your child’s provider can provide a range for what that should be.

What are some examples of good foods for my child to eat?

Select a variety of foods so your child can get all the nutrients they need. Here are some examples of foods that are nutritious and can help support healthy cholesterol levels.

Breakfast:

• Fruit
• Whole grain cereal
• Oatmeal
• Greek yogurt

Lunch and dinner:

Follow the USDA MyPlate model by filling your child’s plate with:

• Lean protein like chicken, fish and beans (1/4 of the plate)
• Whole grains (1/4 of the plate)
• Fruits and vegetables (1/2 of the plate)
• 1 serving low-fat dairy

Healthier cooking methods are baking, broiling, grilling and air frying. Avoid deep frying.

Snacks:

• Fruits
• Vegetables
• Nuts and seeds
• Whole grain crackers
• Low-fat dairy

Beverages:

• Choose water and low-fat milk.
• Avoid soda, sweetened milk, juice and sports drinks.

When should I take my child to see a healthcare provider?

Your child’s provider will tell you how often you should come in for appointments. Your child may need blood tests on a regular basis to monitor their cholesterol levels. They’ll also need testing after six months of dietary changes and/or after two months of a new medication.