You don't need a high cholesterol reading or a medical specialist to improve your family's diet and exercise habits -- the first steps in cholesterol intervention for children. The basic principles of both approaches are outlined below. But when a child's cholesterol levels remain high despite such changes, and when other risk factors are present, a pediatric cardiologist may prescribe medications, including the ones also listed here.

Diet To keep family cholesterol levels low, the National Cholesterol Education Program recommends a diet with less than 10 percent of calories from saturated fat, an average 30 percent or fewer calories from fat overall and fewer than 300 milligrams of dietary cholesterol a day. For example, if your child eats 1,800 calories per day (within the range considered normal for school-age children, though levels vary by age, height, weight and other factors), he or she can have 20 grams of saturated fat per day and up to 40 grams of unsaturated fat.

Restrictions are not advised for children under 2 years of age, who need more calories from fat. Parents should also take care to see that children get enough calories to maintain a healthy weight.

Some foods can help you reach these target levels. Peter Kwiterovich, director of the lipid center at Johns Hopkins Children's Center, says the margarines Take Control and Benecol can lower cholesterol by 10 percent. These products are fortified with plant-based esters, which interfere with cholesterol absorption in the intestines. Eating soybean products can also help, as can increasing consumption of soluble fiber, which is found in oat bran, oatmeal, beans, barley, citrus fruit, strawberries and apples. Studies have linked diets high in soy protein and soluble fiber with a reduction in low-density lipoprotein (LDL), the "bad" cholesterol.

If you're worried about saturated fat in your child's diet, choose foods including lean meats such as sirloin, chicken (without skin) and pork tenderloin; skim milk; frozen yogurt; unsaturated oils (corn, canola, olive and sesame); and fresh, frozen or canned vegetables. Decrease fatty foods such as regular ground beef and bacon; all fried meats; whole milk, ice cream and butter; and vegetable dishes made with butter, cheese or cream sauce.

Exercise Although the link between lowering bad cholesterol and exercise in children is not firmly established, studies show that physical activity can raise children's good cholesterol and lower triglycerides. (Most fat is stored in the body in the form of triglycerides, and some studies have linked excess triglycerides to heart disease.) Physical activity can also help children lose weight, which helps to lower bad cholesterol.

Steven Daniels, a pediatric cardiologist at Cincinnati Children's Hospital Medical Center and a spokesman for the American Heart Association, recommends both diet and exercise for his patients with high s But rather than prescribe a strict regime that children won't follow, Daniels tells parents simply to get their kids moving.

"With our patients, we talk about them finding activities they like to do, activities that give them a sweaty head," he says. He also suggests that sedentary activities, such as computer use and television watching, be limited to two hours a day. "Kids really need an approach that reinforces what they are doing. For them it has be fun," Daniels says.

Medications When dietary changes are not effective, the National Cholesterol Education Program recommends drug therapy for children aged 10 and older who have LDL cholesterol readings above 190 mg/dL -- or 160 mg/dL if they have other risk factors such as a family history of early cardiovascular disease. Either of two types of medications are used: resins, which bind to the precursors of cholesterol in the gastrointestinal tract, or statins, which block cholesterol synthesis.

Research shows that statins are generally safe in children, but long-term studies are lacking. Known risks of statins in children include myositis -- muscle inflammation that can lead to a breakdown of muscle tissue and kidney problems. The problem is reversible, if caught early.

On the plus side, statins are more effective and easier for children to take than the resins, which are given in four to six large daily pills that can cause constipation and other side effects.

-- Elizabeth Agnvall

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