Every child should be tested for high cholesterol between ages 9 and 11 so steps can be taken to prevent heart disease later on, a panel of doctors urged Friday in new advice that is sure to be controversial.
Until now, major medical groups have suggested cholesterol tests only for children with a family history of early heart disease or high cholesterol and those who are obese or have diabetes or high blood pressure. But studies show that is missing many children with high cholesterol, and the number of them at risk is growing because of the obesity epidemic.
The recommendations are in new guidelines from an expert panel appointed by the National Heart, Lung and Blood Institute and endorsed by the American Academy of Pediatrics.
They also advise diabetes screening every two years starting as early as 9 for children who are overweight and have other risks for Type 2 diabetes, including family history.
Autopsy studies show children already have signs of heart disease even before they have symptoms. By the fourth grade, 10 percent to 13 percent of U.S. children have high cholesterol, defined as a score of 200 or more.
Fats build up in the heart arteries in the first and second decade of life but usually don't start hardening the arteries until people are in their 20s and 30s, said one of the guideline panel members, Dr. Elaine Urbina, director of preventive cardiology at Cincinnati Children's Hospital Medical Center.
"If we screen at age 20, it may be already too late," she said. "To me it's not controversial at all. We should have been doing this for years."
Doctors recommend testing between ages 9 and 11 because cholesterol dips during puberty and rises later.
The guidelines say that cholesterol drugs likely would be recommended for fewer than 1 percent of kids tested. Most children found to have high cholesterol would be advised to control it with diet and physical activity.
And children younger than 10 should not be treated with cholesterol drugs unless they have severe cholesterol problems, the guidelines say.
The guidelines also say doctors should:
—Take yearly blood pressure measurements for children starting at age 3.
—Start routine anti-smoking advice when kids are ages 5 to 9, and advise parents of infants against smoking in the home.
—Review infants' family history of obesity and start tracking body mass index, or BMI, a measure of obesity, at age 2.
The panel also suggests using more frank terms for kids who are overweight and obese than some government agencies have used in the past. Children whose BMI is in the 85th to 95th percentile should be called overweight, not "at risk for overweight," and kids whose BMI is in the 95th percentile or higher should be called obese, not "overweight — even kids as young as age 2, the panel said.
"Some might feel that 'obese' is an unacceptable term for children and parents," so doctors should "use descriptive terminology that is appropriate for each child and family," the guidelines recommend.
The guidance was released online Friday by the journal Pediatrics and will be presented Sunday at an American Heart Association conference in Florida.
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Marchione reported from Milwaukee
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Online:
Guidelines: http://pediatrics.aappublications.org/site/misc/2009-2107.pdf