• Cholesterol and Children

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    Should you have your children tested for high cholesterol? Learn more about kids and cholesterol from Dr. David L. Brown.

    Obesity and high cholesterol levels in children are becoming disturbing trends, but do your children really need to have their cholesterol checked?

    If you're an adult, leaving your high cholesterol levels unchecked and untreated could have serious consequences, possibly leading to a heart attack or stroke. In order to prevent these complications, it is recommended that you have your cholesterol checked at least every five years after the age of 20.

    However, there has been a debate over whether or not children should also have their cholesterol levels checked. Studies have shown that atherosclerosis often begins very early in life in the form of fatty streaks on the inner walls of arteries. Most of these fatty streaks will not result in plaques that can slow blood flow to vital organs in the body. But some of these might lead to atherosclerosis later on in life -- placing your child at risk for heart disease later on in life. It is thought that addressing high cholesterol levels earlier in childhood could prevent many complications in adulthood.

    1. Should Your Child Have a Cholesterol Test?
    2. What Other Heart Disease Risk Factors Should Be Checked?
    3. What Does Cholesterol Testing and Monitoring Involve?
    4. What Lifestyle Changes Will Help Lower Your Child's Cholesterol?
    5. How Can You Get Your Kids to Eat and Enjoy Healthy Foods and Activity?
    6. What Are Some Healthy Meal Ideas for Your Children?
    7. How Can You Pack a Healthy Lunch When You Don't Have Much Time?



    Should Your Child Have a Cholesterol Test?

    The American Academy of Pediatrics currently recommends that children who are at risk for high cholesterol should have their cholesterol tested sometime after the age of two and before the age of ten. If your child has the following risk factors for heart disease, your doctor may want to test your child's cholesterol levels:

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    What Other Heart Disease Risk Factors Should Be Checked?

    Children who are older than 2 years old and at risk of having high cholesterol should also be checked for other modifiable risk factors for heart disease, including:

    After you know the results of these screening tests, you can determine if lifestyle changes are needed. If so, your child's risk for heart disease can be lowered if you improve blood pressure, manage weight, prevent or manage diabetes, avoid cigarette smoke and decrease sedentary behavior.

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    What Does Cholesterol Testing and Monitoring Involve?

    Cholesterol testing in your child is similar to that for adults -- blood is drawn from the arm and the child must have fasted for at least 8 to 12 hours in order to have an accurate result.

    Desirable Cholesterol Results in Children

    Total Cholesterol Less than 200 mg/dL
    LDL Cholesterol Less than 130 mg/dL
    HDL Cholesterol More than 40 mg/dL

    Less than 150 mg/dL for adolescents
    Less than 130 mg/dL for younger children

    If your child's lipid panel is normal, then his or her cholesterol should be rechecked in three to five years. If your child's cholesterol is too high, lifestyle modifications -- and sometimes medication, usually a statin -- may be needed to lower it. Your child's pediatrician will decide which treatment is appropriate and will have your child return at regular intervals to check cholesterol and other tests as needed.

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    What Lifestyle Changes Will Help Lower Your Child's Cholesterol?

    Changing the way you eat and reducing sedentary behaviors are the best ways to begin to lower your child's cholesterol. Heart-healthy guidelines are appropriate for most family members over the age of 2. And keeping kids moving with plenty of physical activity is always better than sedentary behaviors like watching television and playing video games. To summarize, the American Heart Association recommends the following heart-healthy lifestyle changes for children and their families:

    • Eat vegetables and fruits and limit juice intake.
    • Use vegetable oils and soft margarines low in saturated fat and trans fatty acid instead of butter or most animal fats.
    • Eat whole-grain rather than refined-grain bread and cereals.
    • Reduce intake of sugar-sweetened beverages and foods.
    • Use nonfat or low-fat (one percent) milk.
    • Increase fish consumption, use only lean cuts of meat and reduced-fat meat products, and remove the skin from poultry.
    • Reduce salt intake.
    • Teach about a balanced meal, portion size and caloric contents of snacks
    • Encourage eating at home. Follow tips for heart-healthy dining out.
    • Perform daily moderate activity for 60 minutes.

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    How Can You Get Your Kids to Eat and Enjoy Healthy Foods and Activity?

    Children definitely don't eat or exercise the same way adults eat and exercise. So, there are a few different approaches you can take in getting them to eat and enjoy healthy foods and activities. But remember, making a healthy lifestyle overhaul can seem like a huge undertaking, so start small. Try to set small goals and start a plan, changing one thing at a time and sticking with that change before adding another.

    1. Eat and enjoy healthy foods and activity yourself.

    Set an example and model the healthy behavior your want your kids to have. Research shows this is the most powerful way to motivate your child to be an adventurous eater who will try new foods and activities and like them.  And if you're not an adventurous eater who likes healthy foods? Try to become one. This involves keeping an open mind, serving new foods such as fruits, vegetables and fish, and trying at least one bite. And don't forget to refrain from making unpleasant faces and comments to influence your child's (or spouse's) reactions. Repeat this with particular foods at least ten times-sometimes it takes that long, or longer, to come around. But it's worth it in the long run if your children learn to love healthy foods for a lifetime.

    2. Eat at least one meal a day at the table with your children.

    Studies have shown children in families who eat meals together eat more fruits and vegetables, less fat and fewer snack foods than children who eat separately from parents. These kids may even do better in school. So, turn the television off and enjoy each other as you sit down to a meal. It doesn't have to be a fancy meal, but the ritual of simply sitting down to share a selection of healthful foods, in reasonable portions, with nurturing conversation is invaluable. But whether you are able to eat together or not, it's a good idea to designate the kitchen or dining room as the only place to eat meals and even snacks in order to curb mindless munching.

    3. Involve your kids in the meal planning and preparation.

    Give up some control and let your child choose the theme for the meal, help with the shopping and help with cooking the healthy meal. Children are more likely to eat healthy meals that they've had a hand in preparing. Occasionally let them invite a friend to share in their special meal. Provide them with their own special apron if they want to feel like a star in the kitchen.

    4. Get creative and make healthy eating fun.

    If it makes your child happy and willing to eat the healthy food you have packed, the extra 20 seconds it takes are worth it. Here are some tips to cute things up for your kids' meals:

    • Get cute with the lunchbox by using crafts supplies and picking out fun reusable containers. Try a Japanese-inspired bento box with built-in, small sections for foods. Or let your child pick out his or her own traditional lunch box or bag and then use multiple small containers with different shapes, colors or cartoon characters to add interest along with a variety of small portions of healthy foods.
    • Use fun toothpicks to present food in a unique and more interesting way. Make fruit or veggie kabobs. Or instead of a sandwich, wrap pieces of lean turkey and low-fat cheese cubes on a couple of colorful toothpicks. Or make turkey roll-ups with whole-wheat tortillas, slice and spear with a toothpick.
    • Change up the utensils. Try using colorful forks and spoons. For even more adventure, try providing chopsticks or chopstick trainers (that are attached at the top to teach kids how to use chopsticks)-and not just for Asian foods.
    • Shapes matter! Add a smile to their day by cutting food, such as a sandwiches or low-fat cheeses, into shapes with a cookie cutter.
    • Include special non-food items such as a holiday theme napkin (make it cloth to be good to the planet), a flower, a note from you, or stickers to make lunch interesting, fun and full of love. And they're calorie free!

    5. Don't keep tempting foods in the house.

    If junk food or soda is not in the house, then neither you nor your children will eat it. And you won't be tempted to pick at your children's treats or even their leftovers. Make treats and soda something you only have on special occasions.

    6. Promote some independence with easily-accessible fruits and vegetables.

    Keep a selection of ready-to-eat vegetables or yogurt in the refrigerator. Fill a bowl with fruit and leave it on the counter. Buy fruit cups packed in juice and natural applesauce without added sugar and store it in easily accessible cabinets.

    7. Start a new family tradition-exercise.

    Walk the neighborhood (with the dog if you have one) every day as a family. Go for a bike ride. Join a basketball league together. Plan a family hike on the weekend. Use a family outdoor activity as a reward for good behavior. Try to find activities that you enjoy and then get the whole family involved.

    8. Make time for yourself.

    Schedule a weekly exercise class or find time to attend a healthy cooking class. Make time to get to the doctor for your annual checkups. And if you just can't find the time, go for a walk around the field during your child's soccer practice or take a jog during halftime at your child's football game. Remember, your kids will learn their eating and exercising habits from you, so make sure you are teaching healthy routines.

    9. Get help from health professionals, if needed.

    Nutrition counseling from a registered dietitian that provides information and focuses on behavior change can be a great place to start. Or if you've run out of ideas, nutrition counseling can help you continue to make progress on the path to a healthier lifestyle for your child and yourself.

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    What Are Some Healthy Meal Ideas for Your Children?

    Here are some examples of healthier food options to include at mealtime for your child.

    For Breakfast

    Fruit, high-fiber cereal, oatmeal, yogurt, whole-wheat toast and peanut butter and multi-grain waffles are a few good choices for breakfast foods. Use skim or 1 percent milk rather than whole or 2 percent milk (after age 2, or as recommended by your doctor).

    For Lunch and Dinner

    Bake or grill foods instead of frying them. Use whole-wheat bread or whole-wheat tortillas to make a healthier sandwich. Also, give your child whole-grain crackers with soups, chili and stew (homemade or low-salt varieties). Prepare whole-wheat pasta, beans (including soybeans in the pod or edamame), brown rice (mixed with white rice if desired), fish, skinless poultry or other lean meats. Always serve fresh fruit (with the skin whenever possible) and/or vegetables with meals.

    For Snacks

    There are many possibilities when it comes to sensible snack ideas, including fruits, vegetables, breads and cereals. Here are some additional kid-friendly snacks:

    • Apple slices and peanut butter
    • A low-fat cheese stick and grapes
    • A small handful of homemade trail mix: cereal, raisins or other dried fruit, nuts, pretzels and a few dark chocolate chips
    • 100 percent fruit leathers
    • Low-fat yogurt or cottage cheese (mixed with fruit)
    • A homemade fruit smoothie or fruit-yogurt smoothie [link to recipe]
    • Hummus with veggies or whole-wheat crackers
    • Salsa served with homemade chips: whole-grain tortillas cut into triangles and baked until crisp
    • A mini pizza: a whole-wheat sandwich round topped with pizza sauce, low-fat mozzarella cheese and vegetables
    • Celery with nonfat or low-fat cream cheese

    For Drinks

    Try making it a rule to drink water with every meal to help lower calories at mealtime. There will be fewer opportunities for high-calorie, high-sugar beverages such as juices and soda.

    • Fruit water is a fun way to get some flavors into water without sugar. It is also refreshing, looks pretty and is quick. To make it, cut up a fruit (for example, strawberries, cucumber, watermelon, peaches, lemons, limes or oranges) and add to a pitcher of water along with some finely chopped herbs (such as rosemary, basil, mint or lemon balm). Put in the fridge. The pitcher can be re-filled with water a few times. Discard after three days, or earlier if necessary.
    • Cucumber Strawberry Water: Combine ½ of a cucumber and as many strawberries as you would like in a big water pitcher. Put it in the fridge & enjoy!
    • Lime mint cucumber water: Combine ½ of a cucumber, chop a sprig of mint and squeeze a few lime wedges into a big water pitcher. Put it in the fridge and enjoy!
    • When juice is desired, choose 100-percent juice, limit to four to six ounces per day and dilute it in half with water to make it go further. Or try diluting it with seltzer water to make a more natural "soda" with fewer calories from sugar.

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    How Can You Pack a Healthy Lunch When You Don't Have Much Time?

    Sometimes time is of the essence and you may find it hard to find time to plan healthy meals in advance for your children. Healthy foods can be convenient, too. And while you may sometimes find that buying individual portions costs more, the convenience and portion control they provide may be worth the price. So, follow these tips to practice your multi-tasking and planning skills, which will help you prepare healthy meals, including lunches, even when you are strapped for time.

    • Create a healthy lunch plan for the week and have all of those items on hand. This way you avoid the stress of "What am I going to pack today?"
    • Place food portions for meals in bags or containers ahead of time: things like crackers, fruits, low-fat cheese portions, whole-grain goldfish, etc.
    • Buy individual portions of healthy items such as yogurt, cottage cheese, low-fat cheese sticks, raisins, unsweetened applesauce, fruit cups packed in juice, or fruit leathers made with 100-percent real fruit.
    • Use frozen vegetables and fruits in a pinch if running low on fresh produce.
    • Use leftovers from the night before and place in container with separate compartments, if applicable.
    • Make lunch while you are making another meal, like breakfast in the morning or dinner the night before.
    • Use a reusable, colorful water bottle or thermos and fill with water or fruit water. It is less expensive than buying bottled water, it makes drinking water a bit more fun and it's a no-brainer when you're packing lunches.

    The bottom line is you can help your children lower their risk for heart disease by living a heart-healthy lifestyle. Find out what works for you and your children and stick with the changes you make. Stay inspired by reading recipes, trying new foods and activities and continuing to seek healthy lifestyle ideas from health professionals, friends and online sources.

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