Your Toddler Might Need a Cholesterol Test

Oh, sheesh, I thought, not another screening test that requires dragging kids to the doctor. But that's just what the American Academy of Pediatrics now recommends for many children as young as 2. And it's a fasting cholesterol test, no less—the kind where you don't eat for 14 hours before giving up blood. Imagine a hungry, cranky toddler facing a needle. No fun.

Still, Frank Greer convinced me that we parents should take this new directive seriously. "I think this is pretty important," says Greer, a professor of pediatrics at the University of Wisconsin and chairman of the committee on nutrition for the AAP. "If the kid is overweight, he's definitely at risk for cardiovascular disease." One third of all children are now in the danger zone. Greer says, "This will bring it home to the parents that this kid is at risk if they don't do something about it." The new guidelines also for the first time call for kids to get cholesterol-lowering drugs if needed.

In the past, pediatricians recommended that children have cholesterol tests if there was a family history of high cholesterol or heart disease. Well, just about every family has some heart disease. And many parents don't know their own cholesterol numbers, let alone their relatives'. Thus the "targeted" screening method missed up to two thirds of children with high cholesterol. Insurance usually pays for cholesterol testing, but the test is relatively cheap—about $50.

Here's the new advice, in a nugget:

• Children age 2 and older who are overweight or have a family history of heart disease should get a fasting cholesterol test.
• Children should drink reduced-fat milk (2 percent or less) starting at 12 months of age.
• Statins and other cholesterol-lowering drugs can be prescribed to children with high cholesterol starting at age 8.

In the past, docs worried that babies wouldn't get enough fat, which is critical for brain development, if they didn't drink whole milk. But young children's fat intake is more than adequate, Greer says, and switching to low-fat milk is the easiest way to reduce the amount of animal fat in their diet.

Here are the recommendations for total cholesterol and LDL (the "bad" cholesterol) in children and adolescents:

• Acceptable: total cholesterol less than 170, LDL less than 110
• Borderline: total cholesterol 170 to 199, LDL 110 to 129
• Elevated: total cholesterol above 200, LDL above 130

If a child is found to have borderline or elevated cholesterol, the first response would be to change the diet to one that's low in saturated fat, high in whole grains and fish, and rich in vegetables and fruits. Cholesterol-lowering drugs are recommended only if a child's LDL level stays above 190, even with a low-fat diet. More exercise also gets the nod, although its cholesterol-lowering power hasn't been tested as much in children as it has in adults.

OK. I'm no longer whining about screening-test mania—or at least not whining in this case. I'm also thinking it has been a while since I've had my own cholesterol checked. Sounds like it's time for a family visit. (The current recommendation for adults is every five years.) The family that fasts together feasts together—after the test.