Fat‐modified diets for children are controversial. Infant nutrition imprints adult lipid metabolism in animals, but evidence is not available for humans. Three intervention trials to reduce total fat, saturated fat and cholesterol intake in children showed small effects on lipid intakes and on serum lipids, but no adverse effects. Serum lipoproteins are associated with coronary artery raised lesions in young adults. Although modifying dietary intakes of children and adolescents appears difficult, changes sufficient to lower plasma cholesterol levels would retard the progression of atherosclerosis and would be safe. Curr Opin Lipidol 9:23–27. © 1998 Rapid Science Ltd