High Cholesterol in Children: Symptoms, Causes, Treatment

What are the symptoms of high cholesterol in children?

High cholesterol in children often doesn’t cause noticeable symptoms on its own. It’s typically detected through routine blood tests rather than presenting with specific symptoms. However, in some cases, particularly when cholesterol levels are extremely high or there are underlying health conditions, children may experience:

1. Xanthomas: These are fatty deposits that can appear as yellowish bumps on the skin, usually around the eyes, elbows, knees, or buttocks.
2. Arcus Senilis: A white or gray ring around the cornea of the eye, which can indicate high cholesterol levels in some cases.
3. Chest Pain: Rarely, high cholesterol levels might contribute to chest pain, especially during physical activity.
4. Family History: Children with a family history of early heart disease or high cholesterol may be at higher risk and should be monitored closely.
5. Other Health Conditions: High cholesterol can sometimes be associated with certain medical conditions, such as diabetes or obesity, which may present with their own symptoms.

Since high cholesterol often doesn’t cause symptoms until it leads to complications like heart disease later in life, it’s important for children to have routine check-ups and screenings, especially if there is a family history of high cholesterol or heart disease. Early detection and management through lifestyle changes and, if necessary, medications can help reduce the risk of cardiovascular problems in adulthood. If there are concerns about your child’s cholesterol levels, speak with their healthcare provider for appropriate testing and guidance.

What are the causes of high cholesterol in children?

High cholesterol in children can have several causes, including genetic factors, lifestyle choices, and certain medical conditions. Here are some common causes:

1. Genetics: Familial hypercholesterolemia (FH) is a genetic condition where the body is unable to remove LDL (bad) cholesterol from the blood efficiently. Children with FH often have significantly elevated cholesterol levels from a young age, even if they maintain a healthy diet and lifestyle.
2. Dietary Factors: Consuming foods high in saturated fats, trans fats, and cholesterol can contribute to high cholesterol levels in children. These include fatty meats, full-fat dairy products, fried foods, and baked goods.
3. Obesity: Being overweight or obese can lead to higher levels of LDL cholesterol and lower levels of HDL (good) cholesterol in children.
4. Lack of Physical Activity: Sedentary behavior and lack of regular physical exercise can contribute to unhealthy cholesterol levels in children.
5. Family History: Children with a family history of high cholesterol or early heart disease are at increased risk themselves, due to genetic predisposition.
6. Medical Conditions: Certain medical conditions can affect cholesterol levels in children, such as diabetes, hypothyroidism (underactive thyroid), kidney disease, and liver disease.
7. Medications: Some medications, such as corticosteroids and certain types of immunosuppressants, can affect cholesterol metabolism and lead to elevated cholesterol levels.
8. Secondhand Smoke: Exposure to secondhand smoke has been linked to higher cholesterol levels in children.
9. Rare Genetic Disorders: In some cases, rare genetic disorders other than FH can also cause high cholesterol levels in children.
10. Stress: Chronic stress may contribute to unhealthy lifestyle habits that can affect cholesterol levels over time.

It’s important for children with risk factors, such as family history or medical conditions, to have their cholesterol levels checked regularly as part of their routine healthcare. Early detection and management through lifestyle changes (diet and exercise) and, if necessary, medications can help reduce the risk of cardiovascular problems later in life. If you have concerns about your child’s cholesterol levels, consult with their healthcare provider for appropriate testing and guidance.

How is the diagnosis of high cholesterol made in children?

The diagnosis of high cholesterol in children is made through a combination of physical examination, medical history, and laboratory tests. Here are the steps involved in diagnosing high cholesterol in children:

1. Medical history: The healthcare provider will ask questions about the child’s medical history, including:
   • Family history of high cholesterol, heart disease, or stroke
   • Diet and eating habits
   • Physical activity level
   • Presence of any other medical conditions, such as obesity or kidney disease
2. Physical examination: The healthcare provider will perform a physical examination to look for signs of potential risk factors for high cholesterol, such as:
   • Obesity or overweight
   • High blood pressure
   • High triglycerides (a type of fat in the blood)
3. Lipid profile test: A lipid profile test measures the levels of different types of lipids (fats) in the blood, including:
   • LDL (low-density lipoprotein) cholesterol (the “bad” cholesterol)
   • HDL (high-density lipoprotein) cholesterol (the “good” cholesterol)
   • Triglycerides
   • Total cholesterol
4. Fasting lipid profile: For this test, the child will be asked to fast overnight (8-12 hours) before the test. This helps to ensure that the liver is not influenced by recently eaten food.
5. Non-fasting lipid profile: In some cases, a non-fasting lipid profile may be done if the child has a condition that requires immediate treatment or if the healthcare provider wants to monitor changes in cholesterol levels over time.
6. Other tests: Additional tests may be ordered to help diagnose high cholesterol or assess risk factors for heart disease, such as:
   • Blood pressure check
   • Liver function tests
   • Thyroid function tests

The American Academy of Pediatrics recommends that children have their first lipid profile test at age 9-11 years old. Subsequent tests may be performed every 3-5 years until they reach adulthood.

The diagnosis of high cholesterol in children is based on the following criteria:

• LDL cholesterol level: ≥130 mg/dL (3.37 mmol/L)
• Non-HDL cholesterol level: ≥130 mg/dL (3.37 mmol/L)
• HDL cholesterol level: <40 mg/dL (1.04 mmol/L) in boys and <50 mg/dL (1.29 mmol/L) in girls

If a child is diagnosed with high cholesterol, the healthcare provider will work with them and their family to develop a treatment plan to manage their cholesterol levels and reduce their risk of heart disease.

What is the treatment for high cholesterol in children?

High cholesterol in children, also known as hypercholesterolemia, is a condition where the level of low-density lipoprotein (LDL) or “bad” cholesterol in the blood is higher than normal. The treatment for high cholesterol in children depends on the severity of the condition and the child’s overall health. Here are some common treatment options:

1. Lifestyle Changes:
   • Diet: Encourage a healthy diet that is low in saturated and trans fats, added sugars, and refined carbohydrates. Emphasize whole grains, fruits, vegetables, lean proteins, and healthy fats like avocado and nuts.
   • Exercise: Regular physical activity can help improve cholesterol levels. Aim for at least 60 minutes of moderate to vigorous exercise per day.
   • Weight management: Maintaining a healthy weight can help improve cholesterol levels.
2. Pharmacological Interventions:
   • Statins: For children with severe hypercholesterolemia, statins may be prescribed to reduce LDL cholesterol levels. Examples include atorvastatin (Lipitor) and simvastatin (Zocor).
   • Bile acid sequestrants: These medications, such as cholestyramine (Questran), can help lower LDL cholesterol levels by binding to bile acids and removing them from the body.
   • Nicotinic acid (niacin): This vitamin B3 derivative can help lower LDL cholesterol levels and raise high-density lipoprotein (HDL) or “good” cholesterol levels.
   • Omega-3 fatty acids: Supplements containing omega-3 fatty acids, particularly EPA and DHA, may help lower triglycerides and improve overall lipid profiles.
3. Other Treatments:
   • Plant sterols and stanols: These natural substances found in foods like fortified spreads and granola bars can help lower LDL cholesterol levels.
   • Soluble fiber: Foods rich in soluble fiber, such as oats, barley, and psyllium, can help bind to bile acids and reduce LDL cholesterol levels.

Important Considerations:

• Children with high cholesterol should have regular check-ups with their healthcare provider to monitor their lipid profiles and adjust treatment as needed.
• Family history plays a significant role in determining a child’s risk of developing high cholesterol. If there is a family history of high cholesterol or premature heart disease, children may need to start treatment earlier or more aggressively.
• Children with other medical conditions, such as diabetes or kidney disease, may require different treatment approaches or more intensive monitoring.

It is essential for parents or guardians to work closely with their child’s healthcare provider to develop a personalized treatment plan that takes into account their child’s individual needs and health status.