These guidelines cover additional topics, such as blood pressure and tobacco exposure, but I will only discuss the most common questions specific to the cholesterol measurements here. A lipid panel includes the total cholesterol, triglyceride level, high density lipoproteins (HDL, "good" cholesterol), and low density lipoproteins (LDL, "bad" cholesterol). Some labs include other types of lipids.
My office website discusses the basics of cholesterol.
The dietary advice is summarized nicely in CHILD-1 Diet and Nutrition Recommendations -Childhood Nutrition Basics.
Preparing for the lab draw
If your child hates needles, I understand. But some things are important, and in pediatrics we focus on prevention. If we can prevent heart attacks, strokes, and other consequences of unknown risks of heart disease, we should.
Kids can be prepared before going to the lab. NEVER say it won't hurt. Everyone perceives pain differently, but if they know it might pinch or feel like a poke they will be prepared. Remind them it only pokes for a very short time usually and holding still helps it go faster. Tell them there will be a big rubber band called a tourniquet that will squeeze the top of their arm to help make it easier for the needle to find the right spot.
Let them watch this video on lab draws. (Warning, this video does show a blood vial being filled... some people get queasy just seeing things like this.)
You can practice at home by letting them show you how they will hold still with their arm out. They can look away and take big breaths with a strong forceful blow out each time. You can wipe the arm with a cotton ball or tissue and talk about how that part tickles. Maybe they can pretend they're blowing out candles or they can blow on a pinwheel.
Make sure they are well hydrated with water before going to the lab. Remind the phlebotomist (who draws the blood) that studies show blowing out upon the insertion of the needle has been shown to decrease pain with injections, and I suspect also with lab draws. You can also use a video on your smartphone or tablet to distract during the draw.
What affects when you should take a child for the lab?
Illness can also affect lipid levels, so ideally children will be overall healthy when the lab is drawn. If there was a recent significant illness, waiting 4-6 weeks to draw the lab is ideal. Significant illness would be one that requires hospitalization or surgery. If oral steroids were given, it would be best to wait at least 4 weeks. An upper respiratory infection, cough, or typical short term illness should simply be resolved before the draw. You would not need to wait 4-6 weeks for these common illnesses. If you are uncertain if an illness is significant, ask your doctor.
If it is not possible to take kids to the lab when they have fasted, be sure the lab knows that it is a non-fasting level. They will include this with the report so the doctor can evaluate the lab values with that important information. In general I do not enforce fasting if it is too inconvenient unless there is a history of a previous elevated triglyceride. If the triglyceride level has been high on a previous lab, it is important to do a fasting level to see if it is a real risk or due to a recent meal.
Why do we need to check cholesterol in children- isn't heart disease an adult problem?
We know that obesity increases the risk of having a high cholesterol and atherosclerosis.
Elevated triglyceride levels and obesity are associated with Type 2 diabetes. Children with obesity need routine monitoring of their cholesterol along with other chronic disease indicators.
There are a significant number of children who have no known risk factors yet have an elevated lipid level. This can put them at risk for cardiovascular disease, but if it is known, steps can be done to lower that risk.
The simple answer is atherosclerosis (clogging of arteries) can begin in childhood, but has no symptoms at the early stages when treatment is most effective. There are some people who have a genetic predisposition to this despite healthy habits and an outward appearance of health.
Screening recommendations are done by age and risk.
|From page 8 of the Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents Summary Report|
What are you going to do with the results?
Repeat levels will be required to see if the diet and exercise changes make an impact. If the results are consistently elevated or significantly elevated to require medication, a referral to a pediatric lipid specialist is indicated.
|See page 53 of the guidelines|
|See page 54 of the guidelines|
If you have questions about cholesterol screening for your child, please talk to your child's doctor.
Pediatric Lipid Disorders in Clinical Practice Workup, Henry J Rohrs, III, MD et al