High cholesterol living in children

Overview

High cholesterol means there is too much of a fatty substance called cholesterol in your child's blood. Over time, this can build up in the walls of blood vessels and increase the risk of heart disease and stroke later in life.

It is becoming more common, especially in children who eat a diet high in unhealthy fats and sugar and do not get enough physical activity. Around 1 in 10 children may have high cholesterol.

It can affect children of any age, but it is more likely in those who are overweight, have a family history of high cholesterol or early heart disease, or have certain medical conditions like diabetes or kidney disease.

Symptoms

Common symptoms

• Most children with high cholesterol have no symptoms at all.

Symptoms in children

• There are usually no noticeable signs in children. In rare cases, a child with very high cholesterol may have yellowish bumps on the skin called xanthomas.

Symptoms in older adults

• Not applicable for this article.

Causes

Main causes

• Genetic causes (familial hypercholesterolaemia) – an inherited condition that makes it hard for the body to remove LDL (bad) cholesterol.
• Unhealthy diet – eating too many foods high in saturated fats, trans fats, and sugar.
• Lack of physical activity – not getting enough exercise to help balance cholesterol levels.
• Being overweight or obese – excess weight can raise bad cholesterol and lower good cholesterol.

Risk factors

• Family history of high cholesterol or early heart disease (before age 55 in men or 65 in women)
• Having a diet high in fast food, fried foods, processed snacks, and sugary drinks
• Being physically inactive (less than 60 minutes of moderate activity most days)
• Having other medical conditions such as type 1 diabetes, kidney disease, or an underactive thyroid

When to see a doctor

See a doctor urgently if:

• If your child has chest pain, fainting, or severe shortness of breath, seek emergency care immediately.

Book a routine appointment if:

• If there is a family history of high cholesterol or early heart disease, talk to your doctor about when to test your child.
• If your child is overweight or has an unhealthy diet and lifestyle, a routine check with a doctor can help assess risk.
• Some guidelines recommend universal cholesterol screening for all children between ages 9 and 11.

Diagnosis

A simple blood test called a lipid panel measures total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol, and triglycerides. The test is usually done after your child has fasted (no food or drink except water) for 9 to 12 hours.

Tests that may be done

• Lipid panel (cholesterol blood test)

What to expect at your appointment

Your doctor will draw a small amount of blood from a vein in your child's arm. Your child may need to fast overnight, so morning appointments are common. Results usually come back in a few days, and your doctor will explain what they mean and what to do next.

Treatment

Treatment starts with healthy lifestyle changes for the whole family. If cholesterol levels are very high or do not improve enough, a doctor may prescribe medication. The goal is to lower cholesterol to a safe level and reduce the risk of future heart disease.

Self-care at home

• Encourage at least 60 minutes of moderate to vigorous physical activity every day (e.g., bike riding, swimming, playing sports).
• Limit screen time to no more than 2 hours per day of recreational screen use.
• Replace sugary drinks with water or milk.
• Cook more meals at home using whole foods like fruits, vegetables, whole grains, and lean proteins.
• Read food labels and avoid products high in saturated fat, trans fat, and added sugar.

Medical treatments

If lifestyle changes are not enough, a doctor may prescribe cholesterol-lowering medications. These are typically only for children with very high levels (especially from genetic causes) and are used under close medical supervision. Never give your child any over-the-counter cholesterol supplements without consulting a doctor.

When is surgery considered?

Surgery is not a treatment for high cholesterol in children.

Living with this condition

Managing high cholesterol is a team effort for the whole family. Focus on making gradual, lasting changes to eating and activity habits. Celebrate small successes and keep communication open. Your child’s doctor and a dietitian can help create a plan that fits your family’s lifestyle.

Lifestyle tips

• Plan family activities that get everyone moving, like walks, bike rides, or dance parties.
• Set regular meal and snack times and avoid eating in front of screens to promote mindful eating.
• Involve your child in grocery shopping and cooking to teach healthy food choices.

Diet and exercise

A heart-healthy diet means plenty of fruits, vegetables, whole grains (like oatmeal and brown rice), lean proteins (like chicken, fish, beans), and healthy fats (like olive oil and avocado). Limit red meat, butter, fried foods, and sugary snacks. Regular physical activity helps raise HDL (good) cholesterol and lower LDL (bad) cholesterol. Aim for at least an hour of activity most days.

Mental health and emotional wellbeing

A diagnosis of high cholesterol can worry a child or make them feel different. It is important to talk honestly and supportively, without blame or shame. Remind your child that they can take charge of their health. If you notice signs of anxiety, sadness, or low self-esteem, talk to your doctor or a school counsellor. If you or your child are having thoughts of self-harm, please contact a crisis helpline immediately.

Prevention

Yes, in many cases high cholesterol can be prevented by starting healthy habits early. Eating a balanced diet, staying active, and keeping a healthy weight are key. For children with a strong family history, early testing and treatment can prevent the worst effects.

Screening programmes

Some health organisations recommend that all children get a cholesterol blood test between ages 9 and 11, and again between ages 17 and 21. Children with risk factors (such as family history or obesity) may need testing earlier or more often. Ask your doctor what is right for your child.

Complications

If left untreated

• Hardening and narrowing of the arteries (atherosclerosis) starting in childhood
• Increased risk of heart attack and stroke in adulthood
• Peripheral artery disease (narrowed blood vessels in the legs)

Long-term outlook

The outlook is very good for children who start healthy habits early. With lifestyle changes and, if needed, medication, most can lower their cholesterol to safe levels and greatly reduce the risk of heart disease later in life. It is never too late to make a change.

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