CHILD-2 Diet Protocol
The CHILD-2 diet is a therapeutic dietary intervention for children and adolescents with elevated LDL cholesterol, consisting of stricter fat and cholesterol restrictions than the CHILD-1 diet, specifically limiting saturated fat to 7% of total calories and dietary cholesterol to less than 200 mg per day. 1
Purpose and Target Population
The CHILD-2 diet protocol is designed for pediatric patients (typically ages 8-21 years) who have persistently elevated LDL cholesterol levels despite initial dietary intervention with CHILD-1. 1 It represents an escalation in dietary management before considering pharmacologic therapy for dyslipidemia. 1
Specific Dietary Components
Fat and Cholesterol Restrictions
- Saturated fat limited to 7% of total daily calories (compared to <10% in CHILD-1) 1
- Dietary cholesterol restricted to <200 mg per day (compared to <300 mg in CHILD-1) 1
- Total fat intake should comprise 25-30% of total calories 1
Implementation Strategy
- Consultation with a registered dietitian is recommended to assess diet quality and measure caloric intake 1
- The diet should be combined with lifestyle modifications including regular aerobic exercise 1
- Trial period of 6 months is typically recommended before reassessing lipid levels 1
Clinical Decision Algorithm
When to Initiate CHILD-2
- After CHILD-1 diet fails to adequately lower LDL cholesterol 1
- When LDL cholesterol remains >130 mg/dL despite initial dietary intervention 1
- Before considering statin therapy in children aged 10 years or older 1
Monitoring and Follow-up
- Repeat fasting lipid panel every 6-12 months to assess response 1
- If LDL cholesterol remains ≥160-189 mg/dL after CHILD-2 trial in children ≥10 years with positive family history or risk factors, statin therapy should be considered 1
- If LDL cholesterol remains ≥190 mg/dL with additional risk factors, pharmacologic intervention is more strongly indicated 1
Important Clinical Caveats
This protocol is specifically for cardiovascular risk reduction in dyslipidemia, not for children with chronic liver disease. 1 While children with liver disease require specialized nutritional management with increased caloric intake (20-80% above normal) and specific macronutrient considerations, 1 the CHILD-2 protocol addresses a completely different clinical scenario focused on lipid management in otherwise healthy children with familial or acquired hypercholesterolemia. 1
The CHILD-2 diet should be distinguished from nutritional protocols for pediatric liver disease, which emphasize calorie-dense formulas with medium-chain triglycerides, normal protein intake, and fat-soluble vitamin supplementation. 1