By Melody Shi, MD, pediatric endocrinologist based in Fairfax
Bone health is often overlooked when it comes to a child’s development and growth. However, 90% of peak bone mass is built throughout childhood and into adolescence, up until 18 to 20 years old. Without a strong foundation, people may face issues in the future, such as early onset osteoporosis.
By ensuring your child is getting enough calcium and vitamin D in the early years, along with a well-balanced diet and plenty of physical activity, you are setting them up for success later in life.
Strong Foundations Start Early
Calcium and vitamin D work together to help support bone growth. While calcium is the actual mineral that gives bone its physical structure, vitamin D allows us to absorb calcium from the food we eat. Over time, these essential nutrients are actively stored in the body and help strong, healthy bone to be laid down.
Calcium is also important for vital organs, including the heart and muscles. If you’re not getting enough calcium in your diet, your body will begin to pull calcium from the bones, causing weaker bones and potentially bigger issues over time.
To make sure a child is getting enough calcium, it’s important to focus on dairy, leafy greens and fortified foods in the diet. Foods like lentils, tofu, broccoli, kale and fortified plant-based milks — such as oat, rice or almond — are all calcium-dense and easy to incorporate into meals if your child is dairy-avoidant. Calcium intake should increase over time for kids, starting with about 700 mg daily from 1 to 4 years old and increasing to around 1,300 mg daily for teens. For reference, one cup of milk has about 300 mg of calcium.
While some foods like oily fish or fortified cereals can be strong sources of vitamin D, the sun is another consistent and easy way for kids to get enough vitamin D. Encouraging plenty of time outdoors, whether it be after-school sports or a daily walk around the block, supports overall well-being and bone health. The recommended vitamin D intake is about 600 IU per day. This typically equates to about 5 to 30 minutes of sun exposure to the face, arms or legs, two to three times per week, depending on skin tone and geographic location.
What Parents Often Ask
1. What are the potential health risks if a child doesn’t get enough vitamin D or calcium?
Bone health issues can manifest in different ways. In childhood, the most common conditions include rickets, a disorder that causes soft, weak bones due to prolonged vitamin D deficiency, and hypocalcemia, which is a low level of calcium in the blood that can lead to muscle cramps, seizures, or abnormal heart rhythms.
2. Are dairy alternative milks still good sources of calcium?
Many dairy alternative milks can be good sources of calcium, but it’s important to check the nutrition label to make sure they are fortified. There has been a correlation in recent years between reliance on non-fortified alternative milks and increased cases of childhood rickets. Oftentimes, added calcium can settle at the bottom of the carton; a quick shake will ensure each pour contains those nutrients. You can even have your child shake up the carton for a fun, interactive activity.
3. How do I know if my child needs a calcium or vitamin D supplement?
If you have concerns about your child’s vitamin D or calcium intake, it’s always best to discuss them with a pediatrician to determine whether a supplement is necessary. During the winter months, when sunlight exposure is more limited, if your child is a picky eater, follows a restricted diet, or seems prone to fractures without significant trauma, these are all reasonable reasons to start a conversation about supplementation.
4. Is there a child population that is more prone to bone issues?
There are specific groups of children who may be more prone to bone health problems, including children who have chronic medical conditions, are on long-term steroids, or are less ambulatory or have limited mobility.
Progress, Not Perfection
When a pediatrician goes over recommended calcium and vitamin D intake, it can sometimes feel intimidating, and some parents may find themselves overly worried about daily totals.
It’s helpful to think of these recommendations as an average intake over time, rather than a number that must be perfectly met every single day. Small, consistent habits, including balanced meals, outdoor play, and routine checkups, go a long way in building strong bones that last a lifetime.
Want to hear more from Children’s National experts? On The Lead in Peds podcast and Rise and Shine blog, pediatric leaders share the stories, science and practical tips shaping children’s health, from major breakthroughs to everyday care.
Feature image, stock.adobe.com
