Children with high blood cholesterol and high triglycerides need medical care and lifestyle management for life, as they are at higher risk for heart diseases like coronary artery disease in later years.

The trouble is that dyslipidemia—or abnormal levels of fats and fat-like substances such as cholesterol and triglycerides in the blood—in children often goes unnoticed and undiagnosed.

Part of the reason for this is the lack of awareness that cholesterol problems can start at any age. Another part of the problems is that high cholesterol doesn't produce any symptoms until it is fairly advanced, and the only way to know if the problem exists is to test for it.

Indeed, some experts abroad have argued that it may be a good idea to test all children for cholesterol problems at birth. Others have insisted that checking blood cholesterol at age 1 might be a better predictor for future heart disease and familial hypercholesterolemia.

As of now, the guidelines in some countries say that children whose parents don’t have high cholesterol should be checked once between the ages of nine and 11 years, and then between 17 and 21 years. Those who have a parent with dyslipidemia or other risk factors for heart disease should have their first lipid profile test aged 2-8.

High cholesterol in children is total blood cholesterol over 200 milligrams per deciliter of blood and over 130 mg/dL of bad cholesterol or low-density lipoprotein (LDL). Good cholesterol, or high-density lipoprotein (HDL), under 45 mg/dL can be seen as a warning sign. A lipoprotein is cholesterol and/or triglycerides wrapped in proteins by the liver, to transport them throughout the body. 

Testing children for high cholesterol is more important today than ever before for three big reasons:

  • Early detection of high cholesterol in children can help doctors devise better preventive care (to prevent or limit the progression of arterial disease, heart disease and other problems) for the children who need it.
  • A type of inherited cholesterol problem—familial hypercholesterolemia—can affect very young children.
  • Additionally, as diets and lifestyles change, the incidence of obesity and diabetes in children is on the rise across the globe. As obesity and diabetes are risk factors for high blood cholesterol and high triglycerides, the incidence of pediatric cholesterol issues is also rising.

The management of cholesterol in children includes lifestyle changes in terms of diet and exercise. Usually, medicines are avoided for children under 10 but doctors take a call on this on a case-to-case basis. (Read more: Foods to control and reduce high cholesterol)

Read on to know more about cholesterol in children, symptoms of high cholesterol in children, causes of high cholesterol in children, risk factors of high cholesterol in children, diagnosis of high cholesterol in children, treatment of high cholesterol in children and complications of high cholesterol in children.

  1. What is high cholesterol in children?
  2. Symptoms of high cholesterol in children
  3. Causes of high cholesterol in children
  4. Diagnosis of high cholesterol in children
  5. Treatment of high cholesterol in children
Doctors for High cholesterol in children

In adults, high blood cholesterol is diagnosed when blood cholesterol exceeds 200 milligrams per 0.1 litres (deciliter or dL) of blood. Low-density lipoprotein levels over 100 mg/dL, triglyceride levels over 150 mg/dL and high-density lipoprotein (good cholesterol) under 60 mg/dL are bad for the body, too.

In children, these values are slightly different. Here’s what the US National Cholesterol Education Program (NCEP) guidelines say about cholesterol levels in children aged 2-18:


Total cholesterol (mg/dL)

LDL cholesterol (mg/dL)

Normal blood cholesterol

Under 170

Under 110

Borderline high cholesterol



High cholesterol

200 or more

130 or more

HDL for children should ideally be over 45 mg/dL. Borderline low HDL is 40-45 mg/dL. Serum triglycerides in children should be less than 100 mg/dL up to nine years of age and under 130 mg/dL from 10-18 years.

Research shows that “Indians living in India” typically have lower total cholesterol and good cholesterol (HDL) than people living in the UK and US, but they have higher triglycerides. Low HDL and high triglycerides are risk factors for arterial diseases like atherosclerosis and blocked arteries.

Before we go further, let's take a look at the uses and benefits of cholesterol in the body, and when does cholesterol become bad:

We have all heard of blood cholesterol and triglycerides in the context of illness. The truth is that the body needs limited amounts of both cholesterol and triglycerides. We need cholesterol for making:

  • Hormones like estrogen, progesterone, testosterone and cortisol among others
  • Cell walls or membranes across the body
  • Bile salts, which helps the body digest fats
  • Vitamin D: our skin needs cholesterol to make vitamin D from sunlight

Triglycerides are used by the body for energy. Whatever is not used for energy, gets stored as fat.

Where do we get this cholesterol and triglycerides? Our liver makes about 1000 milligrams a day of cholesterol. We also get cholesterol from some foods. Triglycerides come from foods such as refined carbohydrates and fatty foods, but it is also made by the liver using excess calories, especially carbs, from food. Triglyceride levels are considered:

  • Borderline high between 150 mg/dL and 199 mg/dL
  • High: 200-499 mg/dL
  • Very high: 500 mg/dL or more

Here's what happens to cholesterol in the body:

The liver makes lipoproteins—cholesterol and triglycerides (both fatty or fat-like substances)  wrapped in proteins—so that cholesterol and triglycerides can be transported to the cells that need them via the bloodstream.

Very low-density lipoproteins (VLDL) and high-density lipoproteins (HDL) are the two types of lipoproteins made in the liver.

VLDL have both triglycerides and cholesterol (a waxy substance) at their core. These lipoproteins travel through the blood to cells that need triglycerides for energy. Once the triglycerides are used up or stored as fat, what’s left behind is low-density lipoprotein (LDL) with cholesterol at its centre.

The body needs cholesterol for vital functions like making hormones and vitamin D. The LDL cholesterol can fulfil these needs. However, if there’s more cholesterol than the body needs, it starts getting deposited on the walls of blood vessels. This damages the blood vessels and makes it possible for plaque to build up there. This cholesterol plaque can make the blood vessels narrower, thus reducing blood flow. This condition is known as atherosclerosis.

If this condition affects the coronary artery that takes blood to the heart, it can lead to coronary artery disease and increase the risk of a heart attack. It can also increase stroke risk if it blocks an artery taking blood to the brain. A piece of plaque can also come away from the blood vessel walls and form a blood clot that can travel to other parts of the body—the blood clot may cause illnesses, including a cardiac event or stroke.

Indians are at high risk of high cholesterol, also known as hyperlipidemia because they naturally have lower HDL and more triglycerides. HDL helps the body get rid of excess cholesterol and cholesterol plaque by taking LDL back to the liver which removes the extra.

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High cholesterol in children doesn’t show any clear symptoms until the problem has advanced quite a bit. Parents or doctors should ask if a test is necessary if the child:

  • Is obese
  • Has a parent or close relative with high cholesterol
  • Eats lots of saturated fats and trans fats (found in many processed foods)
  • Has one of the following health conditions: Kawasaki disease, juvenile idiopathic arthritis, liver disease, kidney disease
  • Has hypertension, diabetes or hypothyroidism

You might have heard of coronary artery bypass surgery—it is one of the most common open-heart surgeries performed in India. The condition that necessitates it—advanced coronary artery disease—starts out with high cholesterol and high triglycerides, which get progressively worse over the years.

There are three main causes of high cholesterol in children:

  • Family history and genes: Inherited conditions like familial hypercholesterolemia can start affecting children from birth.
    Familial hypercholesterolemia is a genetic condition in which the cells of the body are unable to take up LDL cholesterol properly even though they need it. This leaves a glut of LDL in the blood, which gets stored as plaque in the blood vessels. Children with this condition need to be put on statins from the age of eight or 10, to minimise the damage to their blood vessels and hearts.
    Experts say if either parent has dyslipidemia (literally, lipid problems), children should be tested for the same from a young age.
  • Obesity and linked conditions: Research has shown that obesity and conditions linked with it can affect fat metabolism which in turn can lead to a build-up of excess cholesterol and triglycerides in the body.
  • Lifestyle factors: A diet rich in fats and refined carbohydrates, consuming too many calories, low levels of exercise and smoking are linked with high cholesterol and high triglyceride levels in the blood.

The only way to diagnose high cholesterol—in children as well as in adults—by testing for it. The lipid profile test shows values for total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides.

Normal versus high cholesterol in children

Multiple research papers show that total blood cholesterol levels are low in newborns (51.4-96.8 mg/dL for full-term infants), with proportionately higher HDL and lower LDL than in grown-ups (22.1-44.9 mg/dl of HDL or good cholesterol and 22.0-44.9 mg/dL of bad cholesterol or LDL).

Children up to 19 years should have:

  • Total cholesterol: Less than 170 mg/dL
  • LDL: Less than 110 mg/dL
  • HDL: More than 45 mg/dL
  • Triglycerides:
    • 0-9 years: Less than 100 mg/dL
    • 10 and older: Less than 130 mg/dL

For people over 20, fasting lipoprotein profile (on an empty stomach for 9-12 hours) is recommended once in five years. In children who are not at risk of high cholesterol, it is still a good idea to have them tested to avoid complications.

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Lifestyle management and treatment of underlying causes like hypothyroidism or diabetes is the first line of intervention. However, if diet control, exercise and weight management do not help, there are medicines that can help to keep cholesterol—and attendant problems like plaque deposits and premature hardening of blood vessels—at bay. Here are some interventions that your doctor may suggest if your child has high cholesterol:

Lifestyle management for high cholesterol in children

Eating a balanced diet that is low in fats and refined carbs and high in fibre and proteins can help control high cholesterol in some cases. Here's what to eat and what to avoid in pediatric high cholesterol:

  • Eat foods rich in monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA). These include canola oil, avocados, almonds, walnuts, fish like tuna and salmon, fruits and vegetables and whole grains.
  • Try not to consume foods rich in saturated fats and trans fats. These include all ultra-processed foods like packaged chips, ice-cream and cookies, butter, high fat and high salt meats (example, bacon). Experts suggest that the amount of fat in children's diet should not be more than 25-35% of their total calorie intake. Trans fats like microwave popcorn should ideally be cut out completely from children's diet.

In terms of exercise, anything that gets the children excited and gives them plenty of reason to run around for at least half an hour on most days of the week is fine. This could be cycling, swimming, walking, being active in the play gym, etc.

It might be a good idea for everyone in the family to switch to healthier foods and physical activity, to encourage and support the child.

Medicines for high cholesterol in children

In cases where lifestyle changes don't produce the desired results, doctors may put the child on medications such as:

  • Statins reduce the amount of cholesterol that the liver makes
  • Niacin increases HDL production in the liver and reduces LDL and triglycerides
  • Bile acid-binding drugs/resins prevent the reuse of bile after digesting food. Now, the liver needs to make more bile, and for that, it needs to use more cholesterol.
  • Fibrates reduce triglyceride levels and may increase HDL cholesterol
  • Cholesterol absorption inhibitors

Medicines for high cholesterol in children may also be used if:

  • The child has over 190 mg/dL of LDL (bad cholesterol), but no other risk factors for heart disease and diet control failed to bring down cholesterol levels.
  • The child's LDL levels are more than 160 mg/dL, and the child has a family history of heart disease at an early age (under 55 years for men and under 60 for women)
  • The child has some risk factors for hypercholesterolemia like obesity, hypertension or if the child smokes cigarettes, uses tobacco of any kind or drinks alcohol.
  • The child's LDL is over 130 mg/dL, and the child has diabetes.
Dr. Gazi Khan

Dr. Gazi Khan

4 Years of Experience

Dr. Himanshu Bhadani

Dr. Himanshu Bhadani

1 Years of Experience

Dr. Pavan Reddy

Dr. Pavan Reddy

9 Years of Experience

Dr. Purnima Margekar

Dr. Purnima Margekar

8 Years of Experience


  1. Gaddi A., Cicero A.F., Odoo F.O., Poli A.A., Paoletti R., Atherosclerosis and Metabolic Diseases Study Group. Practical guidelines for familial combined hyperlipidemia diagnosis: an up-date. Vascular Health and Risk Management, 2007 ;3(6): 877-86. PMID: 18200807.
  2. Allen R. Last, Jonathan D. Ference and Julianne Falleroni. Pharmacologic treatment of hyperlipidemia. American Family Physician, 1 September 2011; 84(5): 551-558.
  3. Johns Hopkins Medicine [Internet]. Cholesterol and your child.
  4. Ilse K. Luirink, Albert Wiegman, D. Meeike Kusters, Michel H. Hof, Jaap W. Groothoff, Eric de Groot, John J.P. Kastelein and Barbara A. Hutten. 20-year follow-up of statins in children with familial hypercholesterolemia. The New England Journal of Medicine, 17 October 2019; 381: 1547-1556.

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