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Pediatric Health


Help Your Kids Build Healthy Bones


The Right Diet is Important



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December 01, 2008
You wouldn't think that osteoporosis--the brittle bone disease that afflicts 10 million Americans over age 50--is something you need to worry about now for your kids. But now you do. Just ask Maribel Burke, a mother of two from Jacksonville, Florida. Two years ago, her 9-year-old daughter, Christina, mysteriously began breaking bones. Within a span of 18 months, she fractured each arm--twice. "The first time she was just catching a kickball," Burke says. It happened again when another child bumped into her on a slide. As one cast came off, another went on.

Christina's mom finally enrolled her in a bone-density study at Nemours Children's Clinic in Jacksonville, where they received this shocking news: Christina had osteoporosis. The doctor was surprised too—until Burke explained that her daughter's pediatrician had told her to stay away from dairy products because they might be causing her migraines. The doctor at the clinic instructed Christina to start drinking milk again and prescribed a supplement containing calcium and vitamin D. The new regimen has made a huge difference: Christina's bone density has improved, and she hasn't had a fracture since.

While this may sound like an extreme example, a surprising number of kids today have weak bones—and they're getting fractures at an alarming rate. A study comparing the residents of Rochester, Minnesota, from 1999 to 2001 with those of 1969 to 1971, for example, found a 42 percent increase in broken arms, and the biggest jump was among kids ages 8 to 14. "Kids are more calcium deficient than ever before," says Sundeep Khosla, M.D., professor of medicine at the Mayo Clinic College of Medicine, in Rochester, and the study's lead researcher. That's because children are drinking way too much soda and juice, and not nearly enough milk.

Calcium and vitamin D (which helps the body absorb calcium) are essential for children to develop strong, healthy bones. But many kids aren't getting the amount of calcium the American Academy of Pediatrics (AAP) says they need: 500 mg a day for 1- to 3-year-olds; 800 mg a day for 4- to 8-year-olds; and 1,300 mg a day for ages 9 and up. Nearly half of preschoolers and more than 60 percent of 6- to 11-year olds fail to meet their daily calcium requirements. And unless they're drinking four 8-ounces glasses of milk per day (milk is fortified with vitamin D), they're probably falling short on that nutrient as well. The AAP recently doubled the amount of vitamin D it recommends for infants, children and adolescents, to 400 IU a day.

Experts warn that a lack of adequate amounts of calcium and vitamin D can set your child for a bone-density deficit as an adult. "Your child reaches her peak bone mass around age 18, and eventually, it starts to decline," says Susan Coupey, M.D., professor of pediatrics at the Albert Einstein College of Medicine in New York City.

If your child isn't getting her recommended supply of calcium and vitamin D, there's still time to turn things around. Take these steps now to keep her bones healthy for a lifetime.

MAKE MILK A PRIORITY

To get enough calcium, children 4 to 8 should drink at least three 8-ounce glasses of milk per day, which means you should serve milk (or a dairy equivalent, such as 6 ounces of cheese) at every meal. As a calcium source, milk has an edge over calcium-fortified beverages like orange juice. Besides being rich in calcium and fortified with vitamin D, milk has protein and essential vitamins and minerals--including riboflavin, phosphorus and zinc—that help strengthen bones. "Calcium and vitamin-D fortified juices don't provide any of these other nutrients, and they also have a lot of sugar," says Ailsa Goulding, Ph.D., a calcium-research fellow at Otago University in New Zealand.

If your kids don't like the taste of milk, try flavored varieties. A 2002 study in the Journal of the American Dietetic Association showed that children who drank chocolate, vanilla or strawberry milk took in almost 7 ounces more per day than those who drank regular milk. Flavored milk has just as much calcium as the plain stuff, although it does have more calories. But you can reduce them by using light or sugar-free chocolate syrup or powder. Other smart strategies: Switch to low-fat or nonfat milk if your child is 2 or older. You should also stop your child from drinking soda and restrict her juice intake (the AAP recommends no more than 6 ounces of juice per day for children 6 and under).

BE A ROLE MODEL

To keep your bones strong, you need three servings of dairy products a day, too. "Getting enough calcium is a family affair," says Stephanie Smith, R.D., a spokesperson for the National Diary Council in Thornton, Colorado. While all kids need calcium, setting an example for girls (who are more prone to getting osteoporosis later in life) is especially critical. Studies show that daughters whose moms drink milk regularly consume more of it themselves—and drink less soda. Talking about why you still drink milk ("I love the taste, and it's good for my bones") will help your child realize why it's so important.

CHOOSE A SUPPLEMENT

It's best to get calcium and vitamin D from food sources, since the nutrients they contain work together to build bones. But if your child isn't getting enough of either nutrient in her diet, consider a supplement. AAP guidelines now recommend that children take a daily vitamin D supplement if they drink less than one daily quart of milk. For safety's sake, Dr. Heaney suggests buying brand-name products with a reputation to protect, since supplements aren't regulated by the FDA. Pick one your kids will take daily without a fight. If you suspect that your child is falling short on both nutrients, a supplement that combines calcium and vitamin D may be the best alternative. Viactiv Chews (which come in a variety of flavors) are a good choice. Each chew has 500 mg of calcium and 200 IU of vitamin D per serving.

DON'T DITCH DAIRY IF YOUR CHILD IS LACTOSE INTOLERANT

Kids who get tummy aches after they drink milk may not be able to digest its natural sugar, called lactose. One out of four people have the condition, and it's especially common among African Americans, Asians and Hispanics. But according to the AAP, most lactose-sensitive kids can ultimately drink regular milk without getting cramps or diarrhea. "Drinking milk may actually help build up a child's tolerance by fostering good bacteria in the intestines," says Robert P. Heaney, M.D., professor of medicine at Creighton University in Omaha.

Serve your child milk at mealtime, since food helps spread out lactose absorption. Start with a few ounces on his cereal, then gradually increase the amount. If he still can't stomach it, buy lactose-free milk (which costs about $1 more per half gallon than regular milk and tastes different), or give him tablets or drops containing lactase, an enzyme that breaks down the sugar. Even if your child can't drink milk, he may be able to tolerate hard cheeses (which have lower lactose levels than milk) and yogurt with active cultures (which aid digestion).

Another option: Try calcium-fortified soy or rice milk. But keep in mind that these beverages provide only 45 percent of the calcium listed on the label, according to Dr. Heaney's research. Why? "The calcium added to these products separates and settles as sludge at the bottom," he says. "Even shaking the carton isn't enough to resuspend it in milk."

GET YOUR CHILD MOVING

To build strong bones, kids need more than calcium and vitamin D; they need daily exercise. As muscles contract during high-intensity activity, the tendons that attach them tug against your child's bones to stimulate growth. Too many kids live sedentary lives these days. According to one study, preschoolers get just half of the 60 minutes of daily exercise recommended by the Centers for Disease Control. Boost your child's activity level by taking him to the park regularly and letting him play outside as often as possible. If he's old enough, sign him up for a sports program or a martial arts, gymnastics, or dance class. Just 15 extra minutes of running, jumping, and tumbling a day can increase a child's bone strength significantly, says Kathleen Janz, Ph.D., professor of health and sports studies at the University of Iowa.

Sandra Gordon is the author of Consumer Reports Best Baby Products, 2007. She is also a freelance writer and can be contacted at 203-221-7632 or

sgordon1@mindspring.com. Visit her Web site or Blog at www.sandrajgordon.com or www.blogs.consumerreports.org/baby.

CHART: SURPRISING CALCIUM SOURCES

Drinking milk and eating dairy products are the best ways to get your daily calcium, but these foods are greats for your kids' bones too.

Food Serving Size Calcium (mg) Percent RDA*

Total Raisin Bran 1 cup 1,000 125

Honey Nut Cheerios

Milk 'n Cereal Bars 1 bar 250 31

Canned salmon ? cup 240 30

Tofu

(fortified with calcium

sulfate) 1/2 cup 205 26

Wonder Kids Calcium-

Fortified Bread 1 slice 200 25

Kix Cereal 1 1/3 cup 150 19

Edamame (cooked soybeans) 1/2 cup 150 19

Waffles (calcium-fortified) 2 100 13

Sunflower Seeds (hulled) ? cup 84 11

White beans, cooked ? cup 80 10

Almonds 1 oz 75 9

Flour tortilla One 7" round 60 8

Broccoli, cooked 1/2 cup 50 6

*For children ages 4 to 8
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