Tots Popping Pills to Lower High Cholesterol? New Guidelines for at-risk children

Friday Reflection: Cholesterol- Lowering Drugs for Children

Dr. Robyn J.A. Silverman for Dr. Robyn’s Powerful Parenting Blog

As you know, I’m passionate about children’s positive body image— but that doesn’t mean I want us all to throw children’s health into the toilet. Let me know if you feel the same way.

Today, I’m feeling frightened. Have we hit a new low? The diet, physical activity, school lunch options and overall health maintenance plan for school-age children has been so compromised in recent years that the American Academy of Pediatrics is now recommending “statins,” drugs to lower high cholesterol levels, as part of the health plan for “at-risk” children as young as 8 years old. What are we saying to these children about their own ability to be in control and take care of their bodies without having to rely on medical and drug assistance? Part of positive body image comes from feeling in control and positive about your own body health.

“Obviously all of us want kids to really take care of their health,” said Dr. Marcie Schneider, a member of the nutrition committee who is an adolescent medicine specialist in Greenwich, Conn. “We want them exercising, we want them eating well. You try the least invasive things always first, but at some point if that’s not helping enough, you need to go to the next level.”

While some youngsters have genetic predispositions towards higher cholesterol, statins will also be geared towards children as young as 8 years old with LDL (the “bad” cholesterol) at 190 milligrams per deciliter or higher, of those with an LDL of 160 and a family history of heart disease or 2 other risk factors such as being diagnosed medically with diabetes, high blood pressure or clinical “obesity.”

“When you have a kid whose cholesterol looks like an overweight 65-year-old, what do you do?” said Dr. David Ludwig, director of the childhood obesity program at Children’s Hospital in Boston. “The committee had to balance the risks of treating children with powerful drugs, about which there is limited long-term data, with the risks of not treating children with unprecedented cardiovascular disease risk factors.”

The Issue: Concern that children are at risk for heart disease and heart attacks due to high cholesterol.

The New Guidelines: Issued by the American Academy of Pediatrics, citing that children as young as 8 should be put on cholesterol-lowering drugs if they meet the criteria for being “at-risk.”

The Problems: Several problems with these new recommendations have been cited.

Here are a few:

  1. There are no long term studies on how these drugs will affect the children in the long run—especially if they plan to take it for the rest of their life.
  2. The side effects are unknown for children. Adult side effects have been noted; such as cognitive problems and muscle pain.
  3. There is fear that the drug companies are now going to be advertising these drugs for children. “It will open the door for pharmaceutical companies to heavily advertise and promote their use in 8-year-olds, when we don’t know yet the long-term effect on using these drugs on prepubertal kids,” said Dr. Alan Greene, a pediatrician in Danville, Calif., and the founder of the popular Web site
  4. As reported in the New York Times, “We’re talking about potentially treating thousands and thousands of children simply to possibly prevent one heart attack,” says Dr. Sanghavi, from the University of Massachusetts. “That kind of risk benefit calculation is entirely absent from the A.A.P.’s policy.” Dr. Sanghavi, went on to say that statin drugs may affect a child’s endocrine system, which regulates growth and development, among other things. “I, for one, feel unsafe simply saying children are little adults in this case,” he said.
  5. There is no evidence that these drugs will prevent heart attacks later in life.
  6. It’s so easy to pop pills; A “push-button” solution may encourage children to continue eating a poor diet, refrain from getting enough exercise, and embracing an overall positive health maintenance plan. This can lead to many more dangerous health problems and a perceived “lower priority need” for good health education and lunch programs in school.
  7. The drugs are expensive and require consistent blood tests to rule out any complications.
  8. Proposing these kinds of drugs for young children may unleash widespread use of drugs for children.
  9. There is concern that there are financial ties between the doctors who prescribe and the drug companies who supply.
  10. People are concerned that children are not “little adults” and should not be treated as such.

***I’d love to hear the opinions of all you out there on the new guidelines and if you feel that it’s a good move, a cop-out, a poor reflection on the state of children’s health today, or the best solution for our times. What do you think? Please comment below.

Have a powerful weekend!

top image: Jupiter


6 Responses

  1. Robyn, I’m delayed responding as I’d REALLY like to lob this into the court of some of our medical advisors…not just in the diabetes/nutrition realm (though I’ve already pinged Rebecca) but also Dr. Rita Redberg in cardiac care/UCSF, as she’s tackled the kids’ diabetes/heart issues a considerable amount.

    Your heads up on the numbers above have me wide-eyed, esp. #3, 8 and 9 on the media/marketing big pharm front…(if they can market TheraFlu with Happy Feet Penguins, imagine what they could do with statins and cartoon critters…eep.)

    On a personal note, believe it or not, yours truly has high cholesterol (yah, despite, being thin, and the fitness/healthy lifestyle bit, hereditary for me I guess) and I’ve opted NOT to take statins regardless, and just keep trying to shift lifestyle choices…though as one who consumes copious quantities of veggies and fruit, it’s a bit hard to fathom what more I can do…(and ugh, those monster-sized fish oil tabs they want me to take are gross, too!)

    Never been a pill popper, not wild about startin’ now…so I’ll stay au natural and fight the good fight… 😉 (in case that gives you a hint of where I stand with MY bod policy!)

    Also firmly agree that the panacea approach is NOT the direction we want to be sending kids from the get-go…too many ‘easy fixes’ in life that do damage in the long run. Will get back to you on what the medical meisters say…
    Best, Amy

  2. I think it’s a poor reflection on our parenting skills if we can’t make good diet decisions for our kids and have been driven to medicating them. Surely that’s a horse bolting approach? Plenty of fruit, protein , milk and veg and leave the pills in the cabinet.

    (Comment taken from )

  3. It is a bit scary, isn’t it? I would love to see how the cholesterol levels have changed over the last 50 or so years in children.

    The trouble is, that changing the diet and physical activity schedule of children takes more “work” than pill popping.

    We need to start very early getting children into fun physical activities, getting them to drink water over soda, getting good school lunches into them, and teaching them that they can make good choices for their bodies. When we start early, this will actually won’t take any work at all since it will all simply be a habit.

    Thank you for your feedback–

    Dr. Robyn

  4. Thanks for this post, Dr. Robyn. You make many excellent points!

    As a children’s physical activity specialist, I’m appalled by these guidelines. I’ve often referred to AAP guidelines in my writing and speeches, encouraging people to heed them. I now feel that all AAP recommendations are tainted.

    We are indeed a drug-addicted, quick-fix society. Now we will not only be modeling that behavior to children; we’ll be teaching it to them outright.

    I’ve commented often that childhood, rather than being a special phase of life, has become a dress rehearsal for adulthood. But pills instead of play? Who could have imagined such a thing?

    (Comment taken from )

  5. Yes, Rae, I have to agree that the AAP guidelines are a jarring commentary on our quick-fix culture.

    My concerns are very deep that by providing a pill, we will not address any of the “real” issues here– the poor diet, the lack of exercise, and lack of overall health. The pill may “fix” one thing but high cholesterol is a “symptom” which we would now be covering up– a symptom of a larger issue. I wonder what else the poor diets and lack of exercise will bring on as we are treating the high cholesterol! Will we actually be setting our children up for more medical problems? And asking them to rely on meds for the rest of their life is scary.

    In my curriculum next month, I quote Aristotle (not to get too philosophical here), who said; “We are what we repeatedly do; excellence then is not an act but a habit.” I’m afraid that the opposite is also true– that we are making poor choices a habit by addressing them in the way the AAP suggests. While I understand “the need” for the meds, I just can’t believe that this is where we are today– can you believe that we “need” to go down this path since things have gotten so bad with regard to the health of our kids?

    Bring on the 2 Angry Moms, Chef Ann Cooper, some of our excellent Powerful Words schools who are providing the daily exercise in a fun way!

    OK– off my soap box– anyone else want a turn?

    Dr. Robyn

  6. Hi Amy-

    Thanks for your input, above,– it’ll be great to hear what the medical people have to say about all this. Yes, #3, #8, and #9 scare me quite a bit as well!

    My cholesterol tends to run high as well– and there are a few people who have a genetic predisposition towards higher cholesterol. My concern here is that I don’t believe that all of the children who are going to be put on these meds will actually be having a medical predisposition, but rather, just an unhealthy lifestyle.

    Think about what’s happened with ADD/ADHD and meds. So many more people are on it than should be. We’ve got some children, who simply haven’t had enough discipline, some who aren’t sleeping well, some who are acting out for familial reasons, etc and yet we’re calling it ADD. Of course some children actually have ADD legitimately but it isn’t nearly the numbers who take the meds for it!

    With these new cholesterol-lowering drugs for kids, will we be covering something up or over-diagnosing children with high cholesterol (and giving them drugs) when the actual issue is poor diet and lack of exercise? And if we do this, and the poor lifestyle continues, won’t we have a bigger problem on our hands?

    I know you know what I’m saying here. I’ll be eager to hear what others have to say.

    Dr. Robyn

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