Ask the Pediatrician: Dr. Molly

Category: Nutrition

Is your child getting enough calcium?

When I was a kid there weren't a lot of beverage options at mealtime; milk was the only liquid offered. In doing this, my parents were unknowingly setting me up for a lifetime of strong and healthy bones. Today things are different.

When I ask school-aged patients what they drink at meals, few say they have a glass of milk with lunch and dinner. More often than not, they are drinking water, sometimes juice, and once they are teenagers, soda pop. As a result, fewer kids are getting the calcium they need in their diets to make their bones as dense and strong as possible before it is too late.

Virtually all of the calcium that gets embedded in bone gets laid down by the end of puberty. During the time of bone growth, the structure needs to be ready to absorb as much as it can of many nutrients to ensure appropriate growth. Once growth is done, the bones are formed completely and the opportunity to add to their density is greatly diminished. It is for this reason that calcium needs to be a big part of a child's diet.

Once children wean from the breast or formula around a year of age until about 3 years old, they need about 500 mg of calcium each day to meet their minimum requirements. By age 4 that increases to 800 mg per day and once puberty hits, around age 9 or so for the early stages and until about age 18, 1,300 mg a day are recommended. Adults need calcium ,too, but the amount decreases to about 1000 mg per day.

So what's the best way to get the calcium you need each day? Seems my mom was on the right track; milk is the most efficient way to get calcium. In each 8 ounce serving, you get almost 300 mg of calcium. An 8 ounce serving of low fat yogurt with fruit is another good way, delivering about 300 mg of calcium. Cheese can also be a good source but it is more fattening and constipating in large amounts. Calcium-enriched juices are quite good, with about 250 mg of calcium per 8 ounces but it lacks the protein that milk or yogurt provides and is higher in natural sugars.

For a school-aged child to get the 800 mg a day he needs, the easiest way would be to have milk at every meal. For the tween and teenager, drinking milk at every meal and also having yogurt and cheeses can help her get to the 1,300 mg daily recommendation.

For kids who can't drink milk or just don't like it, finding a calcium supplement is tricky. Virtually every calcium supplement for kids, whether it be a gummy or traditional chewable, contains only 200 mg of elemental calcium per chew so four or more of these have to be taken to meet the school age requirement. The package may list a larger amount of calcium carbonate or calcium citrate but because this isn't elemental calcium, only a portion of it gets absorbed. It makes reading the labels challenging, but know that calcium carbonate is 40 percent elemental calcium and calcium citrate is 21 percent elemental calcium. The most calcium dense supplement is Viactiv with 500 mg of elemental calcium per chew. Maximum strength Tums has 400 mg of elemental calcium per chewable and is very economical.

However, milk is the best way to get calcium because it is enriched with Vitamin D, which is essential to absorbing the calcium well and laying it down in bones efficiently. If your child is getting all his calcium from non-milk sources, be sure to give a supplement of Vitamin D as well.