Doctors caring for children should start cholesterol screenings for those as young as two years old to focus on reducing the long-term risk of cardiovascular disease, according to a report published in the July issue of Pediatrics. The policy replaces a ten-year-old statement from the American Academy of Pediatrics on cholesterol in childhood and adds to one issued by the American Heart Association last year.

"I think it is a good thing," said Dr. Luke Bruns, a pediatric cardiologist at St. John's Mercy Children's Hospital. "And it is pretty much what we [pediatric cardiologists] have implemented now for several years."

This AAP paper, much like the 2007 AHA statement, focused attention on the importance of weight. Both recommend that children who are overweight or obese get a screening and a fasting lipid profile. Another factor in determining who should get tested is family history.

The tests are "a response to the epidemic of obesity in children," said Cardinal Glennon pediatrician Dr. Ken Haller. But he adds that it's important to approach each child's case individually considering other factors as well. "Not every kid is going to get cholesterol screened," he said. "Look at if there is a positive family history of cholesterol problems or whether a child is obese and then make judgment of whether or not to [screen]."

The Recommendations

The new guidelines also recommend that screening be done for children with unknown family history or who have other factors for heart disease including obesity, high blood pressure or diabetes.

Children whose cholesterol is normal should then have the test repeated every three to five years.

For children with high LDL ("bad" cholesterol) levels and who are at least eight years old, cholesterol-reducing medications should be considered.

Younger children with high cholesterol levels should be counseled to work on reducing excess weight through healthful diet and increased physical activity. Also recommended is the use of reduced-fat dairy products for children as young as a year old who are -- or are at risk of - of being overweight or obese.

Changing lifestyle and eating habits can be challenge.

"Obesity in children happens in households and involves eating habits that involve the whole family," Haller said. "This makes it difficult to treat. We need to address the reality that a lot of kids are in environments where diet and exercise [alone] are not going to do it."

Drug Nation

While the initial treatment in most cases will often be weight management and improved diet, some children may require medications to lower cholesterol. These medications include the cholesterol-lowering class known as statins. "Most are approved down to 10 years of age," Bruns said.

The new recommendations advise treatment for those as young as eight. And safety concerns remain.

Bruns is reassuring. "Hundreds of children have been studied and there are rare if any side effects," he said. "These studies also looked at any effect of statins on normal growth and development and everything seems fine."

Haller expresses another concern. "The unfortunate thing is that this [new recommendation] can foster a culture where there is a medication for everything. People should not feel that they are off the hook from providing their child a well-balanced diet and adequate exercise."