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Prevention of atherosclerosis should begin in childhood, since several studies have demonstrated that dyslipidemia in childhood is associated with severity of atherosclerotic lesions later in life. Pediatric lipid screening aims to identify children and adolescents with dyslipidemia, including those with more severe, genetic cases and those with mild to moderate lipid increase due to secondary causes. A variety of recommendations related to pediatric lipid screening have been published in the past 25 years, most advocating a targeted approach to screening in those with pertinent family history or risk factors, such as increased body mass index. An expert panel sponsored by the National Heart, Lung, and Blood Institute (NHLBI)2 issued a report in 2011, detailing guidelines for cardiovascular health and risk reduction in children and adolescents. The report included recommendations for targeted screening in children age 2 and older with a positive or unknown family history of dyslipidemia-related cardiovascular disease or other major risk factors. The expert panel recognized the past failure of targeted screening to identify many at-risk youth and, therefore, also included recommendations for universal screening in those aged 9–11 years and again between 17 and 21 years (1). Despite its endorsement by the American Academy of Pediatrics, the universal screening recommendation was met with controversy.

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Perspective
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