Please remember that these are only guidelines. Any concerns should be discussed with your pediatrician.

1.  How much calcium is recommended per day?

The current recommendation for calcium is:

• infants under 1 year-210 to 270 mg daily
• 1-3 year olds-500 mg daily
• 4-8 year olds-800 mg daily
• 9-18 year olds-1300 mg daily

Okay, so how does that translate into a typical child’s diet?  If your 6 year old child drinks a 4 oz glass of milk at each of three meals (150 mg calcium each glass), two pieces of cheese (300 mg calcium for 2 oz) at lunch and a yogurt (225 mg calcium) at breakfast, you are doing pretty well.  Start to read labels and don’t forget the non-dairy sources of calcium (see #3).  Below are some typical foods in a child’s diet and the approximate calcium content.  If you need a more extensive list (I didn’t know beer had 14 mg of calcium!) go to www.nal.usda.gov/fnic/foodcomp/Data/SR17/wtrank/sr17a301.pdf

• milk: 300 mg (1 cup)
• calcium fortified soy, rice or almond milk:  300 mg (1 cup)
• yogurt: 225-300 mg (1 cup)
• American or cheddar cheese: 300 mg (2 oz)
• calcium fortified orange juice: 300 mg (1 cup)
• soft ice cream:  118 mg (1/2 cup)
• oranges:  50 mg (1 medium)
• broccoli:  35 mg (1 ½ cup raw or ½ cup cooked)
• sweet potatoes:  44 mg (1/2 cup mashed)
• oatmeal:  100 mg (1 instant packet)

2.  What about vitamin D?

You may have heard recently that the American Academy of Pediatrics (AAP) has increased the recommended daily intake of vitamin D.  Vitamin D is essential for absorption of calcium which prevents rickets (a bone disease that leads to soft bones, poor growth and bowing of the legs) and osteoporosis.  Recent studies have also suggested that vitamin D can help fight infection and reduce your child’s risk of various illnesses including cancer, diabetes, thyroid disorders and celiac disease.

The AAP recommends that all children get 400 IU of vitamin D every day.  This includes breast fed babies who should be given a daily liquid vitamin D supplement starting shortly after birth. 

Your child’s body makes vitamin D when exposed to sunlight, but it is difficult to measure how much they are getting and how much is safe.  Therefore, it is important that your child is getting adequate amounts of vitamin D in their diet.

What are some good sources of vitamin D?

• fortified milk (a quart of milk has 400 IU of vitamin D)
• fortified soy/rice/almond milk
• eggs
• fortified yogurt (read labels-not all yogurt has vitamin D)
• fish (see www.epa.gov/fishadvisories/advice/   for recommendations to reduce your child’s exposure to mercury)
• fortified cereals and breads
• a little sun (with sunscreen and not if your baby is less than 6 months old)

3.  My child will not or can not drink milk what can I do?

It is true that milk and milk products are the most convenient way to ensure that your child’s diet includes enough calcium and vitamin D.  However, with some careful label reading and menu planning, you can provide adequate amounts of these important nutrients for your child.  Consider the following products that are readily available and contain calcium (and vitamin D in some cases):

• calcium fortified soy, rice or almond milk
• calcium fortified orange juice
• calcium fortified breakfast cereals/oatmeal (might be able to sneak a bit of milk in with these foods)
• calcium fortified breads
• chocolate syrups fortified with calcium
• broccoli (add some cheese!)

Be creative!  Make muffins with milk or a milk substitute.  Add milk or tofu to a smoothie or milk shake.  Put some cheese on eggs.  Serve celery with cream cheese for an after school snack.  Make sweet potato french fries.

4.  What about vitamin supplementation?

Talk to your pediatrician about vitamin supplementation if:

• your baby under 1 year is exclusively breast fed
• your formula fed baby takes less than 1 quart (32 oz) of formula per day
• your toddler eats very little dairy or is unable to eat dairy products
• your child drinks less than 4 cups of milk (32 oz or 1 quart) per day (to be sure that the other sources of calcium and vitamin D are adequate)
• your child is a vegetarian-especially if they do not eat dairy or eggs
• you have concerns about your child’s calcium or vitamin D intake

5.  Just a few more things…

• Children under the age of 1 year should be breast fed or on infant formula, not cow’s milk (cow’s milk does not provide all of the necessary vitamins and nutrients and can cause microscopic intestinal blood loss/anemia in young children).

• Children over 1 year should not drink more than 32 oz of milk per day because of the risk of microscopic blood loss that can lead to severe anemia.
  
  
• One year old children can be changed from formula or breast milk to whole milk (they need the fat of whole milk for optimal brain development).  When the child reaches the age of 2 years, you can switch to 2% and your school age child can switch to 1% or skim milk.
  
  
• Don’t forget about exercise!!  Weight bearing exercise is a very important component of optimal bone health.
  
  
• Set a good example and include exercise and plenty of calcium and vitamin D in your own diet.  Teach your child to read labels and make healthy choices on their own.

Always remember if you are in doubt, check with your pediatrician, no question is a silly one and we are here for you to best care for your children!

About Amy Anzilotti, M.D.