When Should Cholesterol Be Tested in Children and Teens? A Guide for Parents and Providers
Cholesterol screening isn’t just for adults. In recent years, growing awareness of early cardiovascular risk has led to updated guidelines recommending that children and adolescents be screened for cholesterol, even if they appear healthy.
But when is the right time? What are the risks? And how do you know if your child is at risk?
Here’s what every parent should know about cholesterol testing in kids and teens, including when it’s recommended, what the results mean, and what to do next.
Why Cholesterol Matters in Childhood
Cholesterol is a fat-like substance that the body needs to function properly—but too much "bad" cholesterol (LDL) can increase the risk of atherosclerosis (hardening of the arteries) over time.
What’s important to know is that atherosclerosis often begins in childhood, especially in children with risk factors like obesity, diabetes, or a family history of heart disease.
Early screening allows families and providers to:
Detect abnormal levels early
Address lifestyle factors before problems develop
Identify genetic conditions like familial hypercholesterolemia (FH)
Who Should Be Tested—and When?
According to the American Academy of Pediatrics (AAP) and the National Heart, Lung, and Blood Institute (NHLBI), cholesterol screening should occur as follows:
Universal Screening
Once between ages 9–11
Again between ages 17–21
These ages are chosen to avoid the hormonal variability of puberty, which can temporarily affect cholesterol levels.
Targeted Screening (Age 2 and older)
Children as young as 2 years old should be tested if they have any of the following risk factors:
Family history of high cholesterol or early heart disease
Overweight or obesity
Type 1 or type 2 diabetes
High blood pressure
Chronic kidney disease or liver disease
History of Kawasaki disease or chemotherapy
Children with a parent who had a heart attack, stroke, or required a stent before age 55 (father) or 65 (mother) should be tested early, regardless of symptoms.
What Does the Test Involve?
A fasting lipid panel is the most accurate: your child doesn’t eat or drink (except water) for 8–12 hours before the blood draw.
In some cases, a non-fasting lipid panel may be used for screening.
The test measures:
Total cholesterol
LDL (“bad”) cholesterol
HDL (“good”) cholesterol
Triglycerides
What Do the Results Mean?
Lipid Acceptable Borderline High / Low Total Cholesterol <170 mg/dL 170–199 mg/dL ≥200 mg/dL LDL <110 mg/dL 110–129 mg/dL ≥130 mg/dL HDL >45 mg/dL 40–45 mg/dL <40 mg/dL Triglycerides (ages 0–9) <75 mg/dL 75–99 mg/dL ≥100 mg/dL Triglycerides (ages 10–19) <90 mg/dL 90–129 mg/dL ≥130 mg/dL
Source: NHLBI Integrated Guidelines for Cardiovascular Health, 2011
If results are abnormal, your provider may repeat the test and recommend lifestyle changes, further evaluation, or referral to a pediatric lipid specialist.
What Happens If Cholesterol Is High?
Step 1: Lifestyle Focus
For most children and teens, the first-line approach includes:
Balanced meals with fruits, vegetables, whole grains, and healthy fats
Regular physical activity (at least 60 minutes per day)
Limiting sugary drinks and processed foods
Family meals that promote a positive food relationship
Step 2: Medical Intervention
If lifestyle changes don’t improve cholesterol—or if your child has a genetic disorder like familial hypercholesterolemia (FH)—medications like statins may be considered in older children (typically 10 and up) under specialist care.
Children with LDL > 190 mg/dL (or >160 mg/dL with additional risk factors) should be referred to a specialist for further management.
Cholesterol Testing and Eating Disorders: A Special Note
In children and teens with restrictive eating disorders, cholesterol can appear unexpectedly elevated due to metabolic changes and malnutrition. This can be misinterpreted as needing a low-fat diet, which is inappropriate and harmful in this context.
If your child has an eating disorder:
Work with an eating disorder-informed physician or dietitian
Focus on nutritional restoration, not cholesterol-lowering diets
Elevated cholesterol in early recovery often resolves as nutritional status improves
Final Thoughts
Cholesterol screening is a preventive tool—not a punishment. Early detection doesn’t mean something is “wrong” with your child—it means there’s a chance to support their long-term health with knowledge and care.
By approaching cholesterol testing with empathy, education, and collaboration, we can empower children and families to build heart-healthy habits without shame or fear.
References
National Heart, Lung, and Blood Institute. (2011). Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents.
American Academy of Pediatrics. (2017). Lipid screening and cardiovascular health in childhood.
Daniels, S. R., et al. (2008). Lipid screening in children and adolescents: Current evidence and future directions. Pediatrics, 122(1), 198–208.
Mehler, P. S., & Brown, C. (2015). Anorexia nervosa—medical complications. Journal of Eating Disorders, 3(1), 11.
