Jen Farnell, a Denver mother of two, discovered she had high cholesterol as a teenager. Although her father had a history of early heart attack and stroke, she didn’t know her cholesterol was sky high until she was screened at a local blood drive. Now, after years of taking care of her own cholesterol, she’s doing the same for her 15-year-old daughter and 12-year-old son.

Wait a minute: Isn’t cholesterol an adult problem? Not necessarily, which is why the American Academy of Pediatrics recommends that all children ages nine to 11 be screened at least once. Testing children for high cholesterol can help identify and treat kids early so that they enjoy long, healthy lives.

Family Ties

Bacon, butter, and other fatty foods are the most notorious culprits of high cholesterol. You may not know that high cholesterol is also an inherited disorder passed down through families, coupled with an increased risk for early heart disease.

“The main reason (for screening) is to detect children and adolescents who have genetic reasons for having high cholesterol,” says Stephen Daniels, pediatrician-in-chief at Children’s Hospital Colorado. One in 250 children and adults have this genetic disorder called familial hypercholesterolemia (FH), which causes high LDL, or “bad” cholesterol, from birth.

“So it’s actually a pretty common genetic abnormality, and one that I think is important for parents to know if their children have it,” says Daniels. FH is a treatable condition in children and adults that can be managed by taking medications, and making changes to diet and exercise.

Keep in mind that FH runs in families, so if you have it then each of your children has a chance of inheriting it. It works both ways, too. If your child has FH, then there’s a chance that you or your spouse may have undiagnosed FH.

Farnell and Daniels both say that parents may not know that they themselves have FH, and so their child’s high cholesterol can be a wake-up call, helping to screen and identify other family members with the disorder. Ninety percent of people with FH are undiagnosed. And Daniels says FH often occurs in children who are normal weight—surprising some parents.

What Parents Need to Know

For Farnell, knowing she had FH raised her awareness for testing for cholesterol in her own children. Her son Owen was diagnosed when he was six years old, and has taken a cholesterol-lowering drug called a statin since he was 10. He’s also physically active and tries to eat wholesome nutritious foods. Farnell’s daughter has not been diagnosed with FH, although the family watches it closely since her cholesterol is elevated. “It definitely affects your lifestyle, but in a good way,” says Farnell. “We eat a heart healthy diet,” adding that she also tries to keep stress levels down and not overcommit her family for too many things.

High cholesterol contributes to atherosclerosis or “hardening of the arteries,” which can cause serious health problems like heart attack, stroke, or even death. The goal of treatment is to reduce cholesterol throughout childhood and into adulthood to prevent an early heart attack or stroke.

Your child’s cholesterol can be tested with a simple blood test in a pediatrician’s or family doctor’s office. If the result comes back high, your doctor may recommend another blood test for confirmation (a fasting test like the ones we get as adults). A blood test can also identify children with other cholesterol problems like low HDL “good” cholesterol or high triglycerides from eating too much fatty food and not exercising enough. Lifestyle changes can help these children, too.

So why is nine, 10, or 11 a magic age for testing all children for cholesterol? It turns out that changes during puberty can affect cholesterol levels in teens. (See more about testing for cholesterol at other ages below.)

High cholesterol is not a new phenomenon, says Daniels: “It’s something that’s been going on for a long time.” Learning about the genetic causes of high cholesterol and their prevalence have underscored the importance of measuring cholesterol in children and changed approaches to screening in the past decade. There is a genetic test for FH, but it’s not often necessary for diagnosis. A rare and more serious form of FH occurs when a child inherits copies of the gene mutation from both parents. Find out more about these disorders at the FH Foundation.

Schedule for Cholesterol Screening in Children

• Age two and up: Test children with a family history of high cholesterol or with relatives (parents and grandparents) who’ve had a heart attack or stroke at a young age.
• Ages nine to 11: Test all children once.
• Ages 12 to 17: Test children with a family history of early cardiovascular disease or if a child develops other risk factors like obesity, high blood pressure, or type 2 diabetes.
• Ages 17 to 21: Test all adolescents once.

Tips for Parents

• Update your family history at each of your child’s checkups. Be sure to mention any recent heart attacks or strokes in parents, grandparents, aunts, and uncles.
• Get your own cholesterol tested. Tell your pediatrician if you or another family member has recently been diagnosed with high cholesterol.
• Don’t assume that how you or someone else looks is an indicator of high cholesterol or heart disease. A blood test is the only way to confirm.