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Careful with new cholesterol guidelines for kids, local doctors say

Shawn Doherty  —  7/08/2008 6:17 pm

In the wake of aggressive new guidelines for the screening and medication of even very young children for cholesterol, several local pediatricians are advising parents to focus first on exercise and better nutrition rather than prescription drugs when problems arise.

On Monday the American Academy of Pediatrics revised 10-year-old guidelines to recommend that some children as young as age 2 with a family history of heart problems or with other risk factors such as obesity be given a blood test for cholesterol levels. The AAP also lowered the age to 8 at which treatment with prescription drugs be considered for the treatment of elevated cholesterol levels in some cases.

Several local pediatricians voiced reservations about the more aggressive recommendations.

"The big question is what kind of straight line can we draw from the detection of cardiovascular disease in children to the development of that disease in adulthood?" pointed out Dr. David Allen, a UW pediatrician.

Given the relative newness of the phenomenon of young children with the kinds of elevated cholesterol levels doctors ordinarily would see in adults, there hasn't been enough time to watch what happens to these children when they grow up. Therefore, Allen said, the AAP is "extrapulating backwards," connecting the dots with an educated guess rather than real evidence and research that proves children with high cholesterol levels will grow into adults with serious health problems.

Nor has there been enough time, local doctors said, to collect evidence that medicating these youngsters will curb high cholesterol levels. Not enough is known, either, about possible long-term effects of this medicine in young children, though doctors report that the short-term side effects are less serious than they used to be.

What this all means, Allen said, is that local parents and their family doctor should simply continue to rely on their own experience and judgment as well as on the new AAP guidelines as they decide what to do.

"Most pediatricians, especially in our area, don't tend to follow guidelines hook, line and sinker anyways," he said. "My personal view is that there will be some positive effect from these guidelines, but the aggressive screening will overshoot. While it will pick up some kids who are affected, it will also pick up a lot of kids who aren't. The question and the quandary for local pediatricians is whether the money, the energy, and the anxiety families are going through justifies it."

Local pediatrician Dr. Susan Ehrlich said that the most important thing for parents to do is to encourage these children -- who often tend to be overweight -- to exercise more and eat better.

"Get them away from their computers and television sets," she urged. Ehrlich noted that during the summer, some children actually become less fit because they lack even the exercise they should get during physical fitness classes in school. "The best thing parents can do is to make sure their children get out and play," she said.

Pediatricians also voiced concern about the AAP's recommendation that certain children drink low fat milk, noting that at young ages fat is essential for healthy brain development.

Shawn Doherty  —  7/08/2008 6:17 pm