| Blood cholesterol management |
If LDL-C is above goals, initiate additional therapeutic lifestyle changes, including diet (<7% of calories from saturated fat; <200 mg cholesterol/day), in conjunction with a trained dietitian. |
Goals |
Consider LDL-C–lowering dietary options (increase total dietary fiber with emphasis on viscous fibers (i.e., oat bran, pectin) by using age (in years) plus 5 g up to age 20, when the total remains at 25 g/day (William, Bollella, & Wynder, 1995) in conjunction with a trained dietitian. |
LDL-C <160 mg/dL (<130 mg/dL is better) |
Emphasize weight management and increased physical activity. |
For patients with diabetes, LDL-C <100 mg/dL |
If LDL-C is persistently above goals, evaluate for secondary causes (thyroid-stimulating hormone, liver function tests, renal function tests, urinalysis).
Consider pharmacological therapy for individuals with LDL-C >190 milligrams per deciliter (mg/dL) with no other risk factors for CVD; or >160 mg/dL with other risk factors present (BP elevation, diabetes, overweight, strong family history of premature CVD); or if treatment goals not realized after adequate trial of therapeutic lifestyle change.
|
| Other lipids and lipoproteins |
Pharmacological intervention for dyslipidemia should be accomplished in collaboration with a physician experienced in treatment of disorders of cholesterol in pediatric patients. |
Goals |
Elevated fasting triglycerides and reduced HDL-C are often seen in the context of overweight with insulin resistance. Therapeutic lifestyle change should include weight management with appropriate energy intake and expenditure. Decrease intake of energy-dense snack food high in sugar and sugar beverages such as soft drinks, fruit juices, and sports drinks. |
Fasting triglycerides <150 mg/dL |
If fasting triglycerides are persistently elevated, evaluate for secondary causes such as diabetes, thyroid disease, renal disease, and alcohol abuse. No pharmacological interventions are recommended in children for isolated elevation of fasting triglycerides unless this is very marked (treatment may be initiated at triglycerides >400 mg/dL to protect against postprandial triglycerides of ≥1000 mg/dL, which may be associated with an increased risk of pancreatitis). |
HDL-C >35 mg/dL |
|
| Management of BP elevation |
|
Goal
|
Promote achievement of appropriate weight. |
SBP and DBP <95th percentile for age, sex, and height; with comorbidities, <90th percentile for age, gender, and height |
Reduce sodium in the diet. Emphasize increased consumption of fruits and vegetables. |
| |
If BP is persistently >95th percentile, consider secondary causes (i.e., renal disease, coarctation of the aorta).
Consider pharmacological therapy for individuals >95th percentile if lifestyle modification brings no improvement and there is evidence of target organ changes (left ventricular hypertrophy, microalbuminuria, renal vascular abnormalities). Start BP medication individualized to other patient requirements and characteristics (i.e., age, race, need for drugs with specific benefits) and in collaboration with specialist in pediatric hypertension.
|
| Weight management and treatment goals based on BMI percentile and health status |
|
BMI: <85th percentile (normal weight for height) |
Guiding principles |
Goal: Maintain BMI percentile to prevent overweight |
Establish individual treatment goals and approaches based on the child's age, degree of overweight, and presence of comorbidities. |
BMI: 85th to 95th percentile for age and gender (at risk for overweight) |
Involve the family or major caregivers in treatment. |
Goal: Maintain BMI with aging to reduce BMI to <85th percentile; if BMI >25 (kg/m2, weight maintenance |
Provide assessment and monitoring frequently. |
BMI: >95th percentile (overweight) |
Consider behavioral, psychological, and social correlates of weight gain in the treatment plan. |
Goal: Weight maintenance (younger children) or gradual weight loss (adolescents) to reduce BMI percentile |
Provide recommendations for dietary changes, increasing daily physical activity and decreasing sedentary activities. Recommendations should be tailored to the characteristics, needs, and resources of the child and family, able to be implemented within the family environment, and designed to foster optimal child/family health, growth, and development.
|
BMI: >30 kg/m2 (adult obesity cut point) |
|
Goal: Gradual weight loss (1-2 kg per month [kg/mo]) to achieve healthier BMI |
|
BMI: >95th percentile and comorbidity present (overweight with comorbidity) |
|
Goal: Gradual weight loss (1-2 kg/mo) to achieve healthier BMI; assess need for additional treatment of associated conditions |
|
