Children who are at high risk of having an elevated cholesterol should have their cholesterol tested. Risk factors include having a parent with an elevated blood cholesterol level of 240mg/dl or higher, being overweight, and/or smoking.

Children with an acceptable total cholesterol of less than 170 mg/dl should have a repeat test within 5 years.

Borderline levels (170-199 mg/dl) should be repeated and the two results averaged together. If the average value is greater than 170 mg/dl or if the initial test was greater than 200 mg/dl, then a 12 hour fasting lipoprotein analysis should be done, which includes triglyceride, HDL and total cholesterol levels. LDL levels can be estimated by subtracting the HDL from the total cholesterol.

Testing should also be done for children who have a parent or grandparent that, before age 55, had coronary atherolsclerosis or a myocardial infarction (heart attact), angina pectoris, peripheral vascular disease, cerebrovascular disease (stroke), or sudden cardiac death. Instead of a total cholesterol, in this situation, children should have a 12 hour fasting lipoprotein analysis. Because the results of lipoprotein analysis can be very variable, all children should have the lipoprotein analysis repeated and the results averaged together.

Children with an acceptable LDL cholesterol of less than 110mg/dl should have the test repeated within 5 years. If the average LDL cholesterol is boderline, between 110 and 129 mg/dl, steps should be taken to reduce other risk factors for coronary heart disease (smoking, being overweight, inactivity, high blood pressure), the child should be placed on the American Heart Association Step One diet and have the tests repeated in a year. High LDL cholesterol levels, greater than or equal to 130 mg/dl, require further evaluation, including testing other family members, evaluating for secondary causes of high cholesterol and familial disorders and an intensive clinical intervention should be started, which might include drug therapy if diet therapy (Step One then Step Two diet) fails.