Heart disease is rare in children, but risk factors that develop in childhood can make it much more likely cardiovascular problems will show up in adulthood. That’s why new expert guidelines recommend all children be screened for high cholesterol at least once between ages 9 and 11.

The recommendation, from the National Heart, Lung and Blood Institute and endorsed by the American Academy of Pediatrics, is part of a larger set of guidelines released today that seek to help pediatricians address heart-disease risk factors during kids’ regular checkups. The road map for heart health begins at birth by emphasizing the importance of breast feeding, and continues with recommendations for a diet low in saturated fat starting at age 1. The guidelines also stress protecting kids from tobacco smoke and encouraging regular physical activity.

Children should be screened for high cholesterol between ages 9 and 11, and again between ages 17 and 21. Previous guidelines, released in 1992, called for screening only in children with a family history of heart disease or high cholesterol. (Since then, childhood obesity rates and diabetes rates have skyrocketed.) Also new is a non-HDL cholesterol test that does not require children to fast.

Among kids with high cholesterol, less than 1% would qualify for cholesterol-lowering medications. Instead, most would be treated with diet and increased physical activity.