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Typically, when parents think about their children’s health, they don’t think about their bones. But building healthy bones by adopting healthy nutritional and lifestyle habits in childhood is important to help prevent osteoporosis and fractures later in life.

Osteoporosis, the disease that causes bones to become less dense and more prone to fractures, has been called “a pediatric disease with geriatric consequences,” because the bone mass attained in childhood and adolescence is an important determinant of lifelong skeletal health. The health habits your kids are forming now can make, or literally break, their bones as they age.

Why Is Childhood Such an Important Time for Bone Development?
Bones are the framework for your child’s growing body. Bone is living tissue that changes constantly, with bits of old bone being removed and replaced by new bone. You can think of bone as a bank account, where (with your help) your kids make “deposits” and “withdrawals” of bone tissue. During childhood and adolescence, much more bone is deposited than withdrawn as the skeleton grows in both size and density.

For most people, the amount of bone tissue in the skeleton (known as bone mass) peaks by their late twenties. At that point, bones have reached their maximum strength and density. Up to 90 percent of peak bone mass is acquired by age 18 in girls and age 20 in boys, which makes youth the best time for your kids to “invest” in their bone health.

What Is Osteoporosis? Isn’t It Something Old People Get?
Osteoporosis is a disease that causes bones to become fragile and break easily. When someone has osteoporosis, it means his/her “bank account” of bone tissue has dropped to a low level. If there is significant bone loss, even sneezing or bending over to tie a shoe can cause a bone in the spine to break. Hips, ribs, and wrist bones also break easily. The fractures from osteoporosis can be painful and disfiguring. There is no cure for the disease.

Osteoporosis is most common in older people but can also occur in young and middle-aged adults. Optimizing peak bone mass and developing lifelong healthy bone behaviors during youth are important ways to help prevent or minimize osteoporosis risk as an adult.

Factors Affecting Peak Bone Mass

Peak bone mass is influenced by a variety of factors: some that you can’t change, like gender and race, and some that you can, like nutrition and physical activity.

  • Gender: Bone mass or density is generally higher in men than in women. Before puberty, boys and girls develop bone mass at similar rates. After puberty, however, boys tend to acquire greater bone mass than girls.
  • Race: For reasons still not well understood, African American girls tend to achieve higher peak bone mass than Caucasian girls, and African American women are at lower risk for osteoporosis later in life. More research is needed to understand the differences in bone density between the various racial and ethnic groups. However, because all women, regardless of race, are at significant risk for osteoporosis, girls of all races need to build as much bone as possible to protect them against this disease.
  • Hormonal factors: Sex hormones, including estrogen and testosterone, are essential for the development of bone mass. Girls who start to menstruate at an early age typically have greater bone density. Those who frequently miss their menstrual periods sometimes have lower bone density.
  • Nutritional status: Calcium is an essential nutrient for bone health. A well-balanced diet including adequate amounts of vitamins and minerals such as magnesium, zinc, and vitamin D is also important.
  • Physical activity: Physical activity is important for building healthy bones, and provides benefits that are most pronounced in the areas of the skeleton that bear the most weight. These areas include the hips during walking and running and the arms during gymnastics and weight lifting.

How Can I Help Keep My Kids’ Bones Healthy?

The same healthy habits that keep your kids going and growing will also benefit their bones. One of the best ways to encourage healthy habits in your children is to be a good role model yourself. Believe it or not, your kids are watching, and your habits, both good and bad, have a strong influence on theirs.

The two most important lifelong bone health habits to encourage now are;

  • proper nutrition
  • plenty of physical activity.

Eating for healthy bones means getting plenty of foods that are rich in calcium and vitamin D. Most kids do not get enough calcium in their diets to help ensure optimal peak bone mass. Are your kids getting enough calcium?

Eating for healthy bones means getting plenty of foods that are rich in calcium and vitamin D. Most kids do not get enough calcium in their diets to help ensure optimal peak bone mass. Are your kids getting enough calcium?

Recommended Calcium Intakes
Age Amount of calcium
(Milligrams)
Infants
Birth to 6 months 200
6 months to 1 year 260
Children/Young Adults
1 to 3 years 700
4 to 8 years 1,000
9 to 18 years 1,300
Adult Women and Men
19 to 50 years old 1,000
51 to 70 years males 1,000
51 to 70 years females 1,200
70+ years 1,200
Pregnant or Lactating Women
14 to 18 years 1,300
19 to 50 years 1,000
Source: Food and Nutrition Board, Institute of Medicine, National Academy of Sciences, 2010.

Calcium is found in many foods, but the most common source is milk and other dairy products. Drinking one 8-oz glass of milk provides 300 milligrams (mg) of calcium, which is about one-third of the recommended intake for younger children and about one-fourth of the recommended intake for teens. In addition, milk supplies other minerals and vitamins needed by the body. The chart on the next page lists the calcium content for several high-calcium foods and beverages. Your kids need several servings of these foods each day to meet their need for calcium.

How Can I Persuade My Daughter to Drink Milk Instead of Diet Soda? She Thinks Milk Will Make Her Fat.

Soft drinks tend to displace calcium-rich beverages in the diets of many children and adolescents. In fact, research has shown that girls who drink soft drinks consume much less calcium than those who do not.

It’s important for your daughter to know that good sources of calcium don’t have to be fattening. Skim milk, low-fat cheeses and yogurt, calcium-fortified juices and cereals, and green leafy vegetables can all fit easily into a healthy, low-fat diet. Replacing even one soda each day with milk or a milk-based fruit smoothie can significantly increase her calcium intake.

Selected Food Sources of Calcium
Food Calcium (mg) Daily Value (%)
Sardines, canned in oil, with bones, 3 oz. 324 32
Cheddar cheese, 1½ oz., shredded 306 31
Milk, nonfat, 8 fluid oz. 302 30
Yogurt, plain, low fat, 8 oz. 300 30
Milk, reduced fat (2% milk fat), no solids, 8 fluid oz. 297 30
Milk, whole (3.25% milk fat), 8 fluid oz. 291 29
Milk, buttermilk, 8 fluid oz. 285 29
Milk, lactose reduced, 8 fluid oz.
(content varies slightly according to fat content; average = 300 mg)
285 to 302 29 to 30
Cottage cheese, 1% milk fat, 2 cups unpacked 276 28
Mozzarella, part skim, 1½ oz. 275 28
Tofu, firm, with calcium, ½ cup* 204 20
Orange juice, calcium fortified, 6 fluid oz. 200 to 260 20 to 26
Salmon, pink, canned, solids with bone, 3 oz. 181 18
Pudding, chocolate, instant, made with 2% milk, ½ cup 153 15
Tofu, soft, with calcium, ½ cup* 138 14
Breakfast drink, orange flavor, powder prepared with water, 8 fluid oz. 133 13
Frozen yogurt, vanilla, soft serve, ½ cup 103 10
Ready to eat cereal, calcium fortified, 1 cup 100 to 1000 10 to 100
Turnip greens, boiled, ½ cup 99 10
Kale, raw, 1 cup 90 9
Kale, cooked, 1 cup 94 9
Ice cream, vanilla, ½ cup 85 8.5
Soy beverage, calcium fortified, 8 fluid oz. 80 to 500 8 to 50
Chinese cabbage, raw, 1 cup 74 7
Tortilla, corn, ready to bake/fry, 1 medium 42 4
Tortilla, flour, ready to bake/fry, one 6″ diameter 37 4
Sour cream, reduced fat, cultured, 2 tbsp 32 3
Bread, white, 1 oz. 31 3
Broccoli, raw, ½ cup 21 2
Bread, whole wheat, 1 slice 20 2
Cheese, cream, regular, 1 tbsp 12 1
Source: Heaney et al. 2000; USDA 2002.
*Calcium values are only for tofu processed with a calcium salt. Tofu processed with a noncalcium salt will not contain significant amounts of calcium.

But My Kids Don’t Like Milk.

Drinking milk isn’t the only way to enjoy its benefits. For example, try making soup and oatmeal or other hot cereals with milk instead of water. Pour milk over cold cereal for breakfast or a snack. Incorporate milk into a fruit smoothie or milkshake. Chocolate milk and cocoa made with milk are also ways to increase the milk in your child’s diet.

Sources of calcium also might include an ounce or two of cheese on pizza or a cheeseburger, a cup of calcium-enriched orange juice, or a small carton of yogurt. Your kids can also get calcium from dark green, leafy vegetables like kale or bok choy, or foods such as broccoli, almonds, tortillas, or tofu made with calcium. Many popular foods such as cereals, breads, and juices now have calcium added too. Check the Nutrition Facts label on the package to be sure.

My Teenage Son Loves Milk, But It Seems to Upset His Stomach. Could He Have Lactose Intolerance?

People with lactose intolerance have trouble digesting lactose, the sugar found in milk and dairy foods. Lactose intolerance is not common among infants and young children, but can occur in older children, adolescents, and adults. It is more common among people of African American, Hispanic, Asian, and American Indian descent.

Most kids with lactose intolerance are able to digest milk when it is served in small amounts, and combined with other foods like cereal. They may tolerate other dairy products such as cheese or yogurt even if milk is a problem. Lactose-free milk products are now available in most stores, and there are pills and drops you can add to milk and dairy products that make them easier to digest.

Be sure to include plenty of foods with calcium in the meals and snacks you plan for your kids. Almonds, calcium-fortified orange juice, tortillas, fortified cereals, soy beverages, and broccoli with dip are a few great choices. Although it’s best to get calcium from food, calcium supplements can also be helpful.

How to Read a Food Label for Calcium

The food label, called Nutrition Facts, shows you how much one serving of that food contributes to the total amount of calcium, as well as other nutrients, you need every day. This is expressed as a percentage of the daily value (%DV) of calcium that is recommended. For labeling purposes, this is based on the daily calcium recommendation of 1,000 milligrams for people 19 to 50 years old. Since children and teens 9 to 18 years old require more calcium, their %DV target is higher, as indicated below:

Age Recommended calcium intake %DV target
9 to 18 1,300 mg 130%DV
19 to 50 1,000 mg 100%DV

Here is an easy rule of thumb for evaluating the calcium content of a food: 20%DV or more is high for calcium. That means it is a high-calcium food and contributes a lot of calcium to the diet. A food with a calcium content of 5%DV or lower contributes little calcium to the diet and is a low source.

If you want to convert the %DV for calcium into milligrams, you can multiply by 10. For example, if a single-serving container of yogurt lists 30%DV for calcium, it contains 300 mg of calcium (30 × 10).

Getting plenty of high-calcium foods every day is important. To meet their calcium needs, children 9 to 18 years old need about four servings of foods with a 30%DV for calcium (300 mg each) or six to seven servings of foods with a 20%DV for calcium (200 mg each) every day. Foods with a lower %DV for calcium are also important to fill gaps and help ensure that your children get all the calcium they need.

source: https://www.bones.nih.gov/health-info/bone/bone-health/juvenile

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