Lipid Screening in Children Clinical Pathway — Primary Care

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Patient Education

Related Pathway

BMI-Based Evaluation/Management, Outpatient Specialty Care and Primary Care

Child Well Visits ≥ 2 yrs Old

History and Physical
- BMI
- Assess Risk Factors for Cardiovascular Disease

No Risk Factors for Cardiovascular Disease

≥ 1 Risk Factor for Cardiovascular Disease

Universal Screening with non-fasting lipid testing
- Once between 9–11 yrs old and
- Once between 17–21 yrs

Selective screening with fasting lipid panel

Non-HDL is ≥ 145 mg/dL

Non-HDL < 145 mg/dL

Any present:

All present:

LDL	≥ 130 mg/dL
TGs	≥ 200 mg/dL
Non-HDL	≥ 145 mg/dL

LDL	< 130 mg/dL
TGs	< 200 mg/dL
Non-HDL	< 145 mg/dL

Obtain 2 fasting lipid panels 2 wks to 3 mos apart
Average LDL results of
2 panels to interpret

Continue universal screening
Do not recommend referral to lipid specialist for isolated low HDL or elevated total cholesterol
Recommend referral to Genetics for HDL < 20

Refer to lipid specialist
New patient ≥ 19 yrs old,
adult lipid specialist

Continue selective screening based on risk profile, typically every 1–3 yrs

Any present:

LDL	> 190 mg/dL
TGs	> 400 mg/dL

Any present:

LDL	130–190 mg/dL
TGs	200–400 mg/dL
Non-HDL	≥ 145 mg/dL

Any present:

LDL	110–129 mg/dL
TGs	130–199 mg/dL

All present:

LDL	< 110 mg/dL
TGs	< 130 mg/dL

Refer to lipid specialist

Diet and Lifestyle Counseling
Repeat labs in 3 mos
Consider nutrition referral
Consider Healthy Weight referral if BMI > 95^th%ile

Diet and Lifestyle Counseling
Repeat labs in 3–6 mos

Recheck at 17–21 yrs

Results remain elevated after lifestyle modification, refer to lipid specialist

Posted: February 2025

Authors:

Evidence

CHOP Programs

Expert Lipid Heart Clinic

Educational Media

Primary Care Perspectives: Podcast for Pediatricians
Episode 156: Lipid Screening
Screening, Evaluation and Management of High Cholesterol in Children and Adolescents

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

Primary Care Clinical Pathway for Lipid Screening in Children

Evidence

CHOP Programs

Educational Media