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Pediatrics Academy Recommends Lipid Check Before Age 10 7-7-08
Cholesterol screening of high-risk children should be done before age 10 and
fasting lipids should be re-checked every three to five years, according to
recommendations just issued by the American Academy of Pediatrics.
High-risk children include those with a positive family history of dyslipidemia
or premature heart disease as well as those who are overweight or obese and
those with hypertension or diabetes, wrote Stephen R. Daniels, M.D., Ph.D., of
Cincinnati Children's Hospital, and others on the academy's Committee on
Nutrition.
The updated recommendations on lipid screening were published in the July issue
of Pediatrics. The committee said that screening should not be done earlier than
age two.
The committee recommended that drugs be considered for patients ages eight or
older "with an LDL concentration of ≥ 190 mg/dL (or ≥ 160 mg/dL with a positive
family history of early heart disease or ≥ two additional risk factors present
of ≥ 130 mg/dL if diabetes mellitus is present)."
No specific drugs were recommended, but the committee wrote that statins have
been tested in children and adolescents and appear to be well tolerated. The FDA
has approved pravastatin (Pravachol) for familial hypercholesterolemia in
children ages eight or older.
Cholesterol-absorption inhibitors (currently ezetimibe [Zetia]) is the only
approved drug in this class) have not been extensively studied in children.
But the known side effects of the drug are limited to "gastrointestinal
discomfort and they come in a palatable, small tablet form," the committee
noted. It concluded that this class of drugs has potential as a first-line
treatment if studies in children confirm efficacy and safety.
Fibrates should be used "cautiously and under the supervision of a pediatric
lipid specialist."
In pediatric trials, niacin was associated with flushing in 76% of children and
elevation of liver enzymes in 26% of children studied. As a result, the
committee concluded that niacin could not be recommended for routine use in
treatment of pediatric dyslipidemia.
Bile acid-binding resins, the committee wrote, were also a poor choice because
gastrointestinal complaints limit their use for young patients.
For children who have either high triglycerides or low HDLs, weight management,
including diet and nutrition counseling as well as an exercise program, should
be the primary treatment.
In addition to recommending cholesterol screening, the academy recommended the
use of reduced-fat milk for children ages 12 months to two years who are
overweight or obese or who have a positive family history of premature heart
disease.
The academy defined premature heart disease as affecting men 55 or younger and
women 65 or younger.
Comment:
I agree, however I would never agree to giving unapproved cholesterol medication to children. If your Childs cholesterol is high than there is something wrong. The problem is usually low thyroid function, make sure your child gets tested for it. In fact I recommend that you have your Childs free t3 tested at 10 or before puberty, so that if treatment is required later in life then you know what is normal for that child.
If all thyroid tests come back normal, check them yourself. There are easy to read and will tell you if something is off. Over 80% of tests I have been handed by patients clearly showed something wrong, yet they were told everything was normal. If the levels are truly normal than liver tests are in order. If those are normal than dietary changes are in order!