Programs to control dyslipoproteinemia (DLP) in childhood have been controversial because of the need for prolonged treatment during phases of rapid psychological and somatic development. The clinical challenge is to detect and provide intense, safe, and effective interventions for a small group of children with DLP. This program should complement changes in lifestyle for the entire population of children over the age of 2 years that limits dietary total fat, saturated fatty acids and cholesterol, although increasing physical activity and preventing smoking. The National Cholesterol Education Program has recommended selective screening with serum total cholesterol in children with parental history of total cholesterol >=240 mg/dL or with serum lipoproteins in children with parental or grandparental history of premature (<=55 years of age) cardiovascular disease (CVD). Incomplete family history information and the young age of many parents diminishes the sensitivity and feasibility of this approach. We recommend universal screening by measuring total cholesterol in all children and lipoproteins in those children with a history of parental premature CVD. This approach should increase the salience of CVD prevention to the children, parents, child health providers, and school authorities. Decreasing dietary fat, saturated fatty acids and cholesterol for these DLP children is safe, effective, and well tolerated. Bile acid binding resins are reserved for older, high cardiovascular risk children with low-density lipoproteins >=160 mg/dL after diet therapy. Treatment of childhood DLP has significant potential to decrease later risk of CVD by delaying the initiation and rate of progression of atherosclerosis.
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