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How strict should a child's diet be?  Should children with FH drink low-fat milk or skim milk?
I think they should consume low-fat milk and low-fat food.  However, it is important that parents make sure their children are not nutritionally deprived and that their growth and development are not compromised.  With a low-fat diet it is important your children get enough calories.

Would you prescribe medication to children?
It depends on the child's family history.  For example, if I see a 12 or 13-year-old  boy with FH whose father had an MI in his 20's or 30s, I would probably start him on medication.  However,  I am more conservative prescribing medication to girls. 

What age should a child start medication?
The earliest age I would prescribe mediation for a child would be 8-10 years old and for boys.  Although, I would more likely start medication between 10-14 years old for boys and post-puberty for girls.

Can an FH person be too old to start medication?   
The older a person with FH gets, their necessity for treatment with medication, in addition to a low-fat diet and healthy lifestyle increases.

Describe a situation in which you would prescribe medication to a child.
If a  12-year-old boy has a cholesterol level of 440,  a high LDL level, a strong family history, where males in the family have died in their 30s of heart attacks,  then I would prescribe medication for this child.

Would you prescribe a statin medication?
A statin medication would be the drug of choice compared to other cholesterol-lowering medications.  The reason is that statin medications are well tolerated and have the best acceptance and best efficacy among patients who take them.

Are there any growth and development problems with statin medications?
No. The statin medications do not affect growth and development in children. This has been carefully evaluated in early research studies of lovastatin (Mevacor) in boys with FH.   These boys had completely normal growth and development.