Aim: To determine whether information about a family history of hypercholesterolaemia or early cardiovascular disease was documented by paediatricians in children and adolescents with elevated low-density lipoprotein (LDL)-cholesterol levels. Methods: Retrospective chart review of all children with a LDL-cholesterol level ≥95th percentile (3.4mmol/L) and ≥99th percentile (3.8mmol/L) at a tertiary paediatric hospital in 2014. Results: Of 86 children with a LDL-cholesterol level ≥3.4mmol/L, only 18 (20.9%) had documentation of a family history of hypercholesterolaemia or early cardiovascular disease. In those 18, 13 (72.2%) had a family history of hypercholesterolaemia and 11 (61.1%) a family history of early cardiovascular disease. Increasing the LDL-cholesterol cut-off level to ≥3.8mmol/L (n=46) did not improve documentation of a family history (9/46, 19.6%). Conclusions: In patients with elevated LDL-cholesterol levels, paediatricians rarely document a positive or negative family history of hypercholesterolaemia or early cardiovascular disease. This represents a lost opportunity to diagnose children and adolescents with familial hypercholesterolaemia.