Should Retail Clinics Screen Children for High Cholesterol?

Recommendations from the American Academy of Pediatrics (AAP) and the US Preventive Services Task Force (USPSTF) do not give retail clinicians clear direction on whether they should screen children for high cholesterol.

The AAP calls for all children aged 9 to 11 years to be screened for high cholesterol as a result of the growing number of obese children, while the USPSTF’s draft recommendations state that there is not enough evidence to determine whether screening children is beneficial.

Courtney Ballina, BSN, MSN, NP, professional services manager at Target Clinics, toldContemporary Clinicthat cholesterol screening is typically limited to adults at this time in Target retail clinics. MinuteClinics, on the other hand, have expanded cholesterol screenings to children.

Ballina also noted that the USPSTF’s recommendations are critical in terms of reimbursement.

“If the USPSTF does not support such screening, insurance companies will not (typically) cover the screening,” she said.

Ballina also explained that retail clinicians already screen for cardiovascular issues in all children by examining blood pressure. If the child’s blood pressure is elevated, then he or she will have to see a pediatrician who will make the call about medication.

“I am not aware of any retail clinics that have a protocol in place to treat children for these issues; therefore, the clinicians are likely hesitant to put the child through a painful procedure simply to refer to primary care and have the test repeated,” Ballina said. “I believe this is another hindrance to testing in the retail clinic.”

However, retail clinicians can still make a difference by consulting patients about the risks of childhood obesity and making recommendations about seeing a primary care provider about high cholesterol testing.

“Oftentimes, the retail clinician is uniquely positioned to do some hands-on training—actually walking into the aisles of the store to teach how to read a food label or make some healthy recommendations for snacks,” Ballina said. “It would be great to further develop our partnerships with primary care providers and pediatricians to offer these kinds of supportive services once they have actually diagnosed a child with high cholesterol.”

The AAP not only calls for cholesterol screening in those aged 9 to 11 years, but also recommends testing in:

• Children whose parents or grandparents had heart attacks or were diagnosed with blocked arteries or diseases affecting the blood vessels before age 56 in men and before age 65 in women.
• Children whose parents or grandparents have total blood cholesterol levels ≥240 mg/dL.
• Adopted children.
• Children who have high blood pressure or diabetes, or those who smoke or are obese.

For these categories of children, the AAP said testing should take place after 2 years of age, but no later than 10 years.

“A recent government report indicated that there is good evidence that children with cholesterol problems become adults with high cholesterol, so it is important to monitor the cholesterol of children who may have an increased risk of elevated cholesterol,” the AAP stated on its website.

Meanwhile, the USPSTF’s draft recommendations, which just closed for comment on January 25, 2016, noted it was “difficult to predict” whether children with high cholesterol will continue to have it in adulthood.

“It also is not clear that identifying and treating high cholesterol in children or adolescents leads to long-term improved heart health in adulthood,” the recommendations stated after reviewing studies of the pros and cons of cholesterol screening.

However, the USPSTF did not find evidence that taking cholesterol medication in childhood led to long-term harm. Nevertheless, it called for more research on the subject.