Synopsis Abnormal lipid levels are relatively common in chil- dren and adolescents, affecting approximately 1 in 5 Confirmed lipid disorders are less common but occur frequently in the presence of obe- sity, often accompanied by cardiovascular risk factors, and contribute to increased rates of cardiovascular and metabolic morbidity and mortality. Severe hypercholes- terolemia (LDL 190 mg/dL ( 4.9 mmol/L)) affects ~1 in 250 children and adolescents. Testing for lipid disorders can identify both severe hypercholesterolemia and mul- tifactorial lifestyle-related dyslipidemia. Nonfasting lipid testing is effective for initial screening purposes, and non HDL-C is a reasonable screening test. No available evidence evaluates benefits of childhood lipid screen- ing for modifying CVD events or associated long-term harm. However, significantly abnormal lipid levels track from childhood to adulthood. Furthermore, subclinical atherosclerosis, as measured by carotid intima-media thickness, is abnormal in children with FH. Strong evi- dence shows that lifestyle modification improves lipid levels in childhood without adverse effects on growth and maturation; however, effect sizes are small, and adherence may wane over time. Statins and nonstatins lower TC and LDL-C with minimal adverse effects in children and adolescents with severe hypercholesterol- emia. There are scant data on pharmacological treat- ment of multifactorial lifestyle-related dyslipidemia. Recommendation-Specific Supportive Text 1. In children and adolescents with lipid abnor- malities and obesity, lifestyle-modification ther- apy should be intensified over and above usual therapy for childhood obesity and should include moderate caloric restriction and sufficient physi- cal activity (eg, 30-60 minutes of moderate to vigorous activity on most days). Utilization of resources for nutritional education and counsel- ing is encouraged. 2. 