• The pediatric approach to the primary prevention of coronary artery disease in adults remains controversial. Measurement and intervention to lower serum cholesterol levels have been advocated recently in a selected group of American children by the Expert Panel on Blood Cholesterol Levels in Children and Adolescents of the National Cholesterol Education Program. This article reviews the clinical and scientific data contributing to the controversy surrounding cholesterol in American children. Arguments in favor of and opposed to an aggressive approach to identifying American children with elevated serum cholesterol levels are presented. The rationale for a selective screening approach is demonstrated.