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Screening Tests for Children (Ages 2 to 12)

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Not everyone in this age group may need screening for every condition listed here. Click on the links above to read more about each condition and to determine if screening may be appropriate for you or your family member. You should discuss screening options with your health care practitioner.

High cholesterol

Beginning in childhood, the waxy substance called cholesterol and other fatty substances known as lipids begin to build up in the arteries, hardening into plaques that narrow the arterial passageways. During adulthood, plaque buildup and resulting health problems occur not only in the arteries supplying blood to the heart muscle but in arteries throughout the body (a problem known as atherosclerosis). For both men and women in the United States, the number one cause of death is heart disease, and the amount of cholesterol in the blood greatly affects a person's chances of suffering from it.

Growing evidence shows that the biological processes that precede heart attacks and cardiovascular disease begin in childhood, although they don't generally cause symptoms or lead to disease until middle age or later. Experts encourage physical activity and healthy eating in childhood and adolescence—appropriately limiting cholesterol, saturated fat, and trans fat—as these may protect against heart disease in adulthood.

Recommendations

In an effort to get an earlier start on cardiovascular prevention, the American Academy of Pediatrics (AAP) released a new guideline in 2011 that included the recommendation that children get routine screening with tests for lipids, including cholesterol. A lipid profile typically includes the following tests: total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides. Non-HDL-cholesterol can also be calculated by subtracting the HDL-C value from the total cholesterol result.

Specifically, the AAP recommends:

  • Ages 2-8 years
    • No routine screening; if no risk factors, no testing needed.
    • If at increased risk, fasting lipid profile twice during this time period.
  • Ages 9-11 years
    • Universal screening; even if no risk factors, non-fasting lipid profile during this time period.
    • If results of concern, fasting lipid profile twice during this time period.

See Teens for recommendations for older youth 12 and up.

For children with unhealthy lipid levels, the AAP recommends dietary and lifestyle changes, including more exercise, as the often-effective first steps. In some cases, medication may be needed, such as if lipid levels do not respond to lifestyle changes. Talk to your child's doctor about what would be appropriate in your child's situation.

Risk Factors

  • Family History: Children are at increased risk if they have a parent, grandparent, aunt/uncle, or sibling who has high cholesterol or if they have a family history of cardiovascular disease (prior to age 55 in male relative and age 65 in female relative).
  • Personal Health: Children are also at higher risk if they:
    • Are overweight or obese
    • Have a diet high in fats, especially saturated or trans fat
    • Get little or no exercise
    • Have diabetes or hypertension (high blood pressure)
    • Have another moderate- or high-risk medical condition
    • Smoke

Links
American Heart Association: Children and Cholesterol
KidsHealth.org: Cholesterol and Your Child 


Sources Used in Current Review

CDC. FASTSTATS – Leading Causes of Death (2009 data). Available online at http://www.cdc.gov/nchs/fastats/lcod.htm through http://www.cdc.gov. Accessed June 2012. 

Kavey R-EW, et al. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report. Pediatrics 2011; 128: DOI:10.1542/peds.2009-2107C. PDF available for download at http://pediatrics.aappublications.org/site/misc/2009-2107.pdf through http://pediatrics.aappublications.org. Accessed June 2012.

KidsHealth.org. Cholesterol and Your Child. Available online at http://kidshealth.org/parent/medical/heart/cholesterol.html# through http://kidshealth.org. Accessed June 2012. 

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