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Drink Your Milk, Enjoy the Sunshine!
Why we need calcium and vitamin D
By Sheryl Zang, Ed.D., FNP, CNS
It is important that children and teens include the four food groups in their daily diet so they get enough calcium and vitamin D. Calcium and vitamin D provide good nutrition on a daily basis, and protect against disease later in life.
Calcium is essential for the heart muscles and nerves to function properly, and for maintaining blood flow. Even more important, it is needed to build strong bones and slow the rate of bone loss that occurs naturally with aging. Calcium reduces teenage broken bones — along with the risk of osteoporosis, which is not visible until later in life.
About 20 percent of adult height and 50 percent of adult weight are gained during the teen years. Most boys double their lean body mass between the ages of 10 and 17. Because growth and change are so rapid during these years, there is an increased need for calcium.
Evidence shows that vitamin D may help prevent serious disease. New research suggests that this important nutrient can boost the immune system, help protect against some cancers and may reduce the risk of type 1 diabetes. Children need vitamin D to keep their bones strong, as vitamin D helps the body absorb calcium. Children and teens who lack vitamin D can have weak teeth and bone softening.
The Right Amount of Calcium
The American Academy of Pediatrics (AAP) daily calcium recommendations are listed in the chart below.
| AGE-GROUP |
Adequate Calcium Intake |
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| Toddlers (ages 1-3) |
500 mg |
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| Children (ages 4-8) |
800 mg |
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| Older children (ages 9-13) |
1,300 mg |
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| Teens (ages 14-18) |
1,300 mg |
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| Pregnant or lactating teens |
1,300 mg |
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| MEETING CALCIUM REQUIREMENTS : Below are food sources of calcium |
| FOOD ITEM |
Serving Size |
Miligrams |
| Milk, whole or low-fat |
1 cup |
300 mg |
| Soy or rice milk |
1 cup |
300 mg |
| Cheese pizza * |
1 slice |
220 mg |
| Ice cream, soft serve |
1⁄2 cup |
118 mg |
| Cheddar cheese |
1 oz |
204 mg |
| Plain, low-fat yogurt |
8 fluid oz |
415 mg |
| Orange juice fortified with calcium |
8 fluid oz |
300 mg |
| Cooked fresh broccoli |
1 cup |
136 mg |
| White or whole-wheat bread |
1 slice |
20 mg |
| Macaroni and cheese * |
1⁄2 cup |
180 mg |
| * Calcium may vary due to ingredients |
The amount of calcium needed by children and teens may seem hard to match during an active day, especially if they are not fond of milk or vegetables. Drinking a cup of calcium-fortified orange juice, eating plain yogurt topped with fruit or granola and having low-fat milk with chocolate syrup can help children reach the amount of calcium that they need to have every day.
Milk and milk products are the best sources of calcium. Along with calcium, milk provides vitamin D, potassium and magnesium. All are essential for the best bone health. Low-fat or nonfat milk is recommended for children over the age of two, as it will add calcium to their diet without the fat. Any 8-oz serving of milk, ranging from skim milk to whole milk, contains 300 mg of calcium. You can also add nonfat dry milk powder to other drinks and food to increase calcium. To get kids to drink milk, add flavorings such as chocolate or strawberry. Make a smoothie by blending milk with fruit, or treat your children to a milkshake by blending milk with ice cream. Substitute milk for water in soups, cereals and gravies. Use milk in deserts such as pudding, rice pudding and custards.
Children and teens have increased their intake of cola and other sodas. Research has shown that a high increase of carbonated beverages reduces the amount of minerals in the bone and makes teenage girls almost four times as likely to break a bone than teenage boys. Teens concerned about calorie intake and weight gain should know that a 12-oz soft drink contains more calories than 12 oz of fat-free milk, without the important nutrients.
Hard cheese that has either low or high fat content is also high in calcium. You can offer cheese as a snack and use it in cooking. Children and teens usually enjoy eating pizza, lasagna, macaroni and cheese, tacos and grilled-cheese sandwiches. Calcium is also found in vegetables such as broccoli, acorn squash, collard greens and spinach. Broccoli can be added to pizza, cheese lasagna or a broccoli-cheddar quiche.
Lactose-reduced and lactose-free milk products are now available in most supermarkets for children or teens who are lactose-intolerant. Symptoms of lactose intolerance include stomach cramping, bloating or diarrhea after eating dairy products. Soy milk, which is fortified with calcium, may also be used as an alternative.
 Being able to read food labels will help parents ensure that their children will get the amount of calcium they need. Calcium content is shown on nutritional labels, usually represented as a percentage, such as 30 percent. The percentage of the daily value is the calcium that you would get by eating one serving of that food. The food label uses 1,000 mg as 100 percent daily value. If a food label states that the particular food has 30 percent calcium, you multiply 30 percent by 1,000 and the amount of calcium is 300 mg.
Younger children do not need 1,000 mg. Instead add up the percentages of the foods they eat and add up the milligrams to get close to the daily requirements for children. Older children and teens need more than 100 percent daily value. With a daily requirement of 1,300 mg, they need 130 percent daily value of calcium.
To maximize a child’s or teen’s calcium intake, choose food products high in calcium. Note the following terms on the packages.
Some foods are labeled “High in Calcium,” “Rich in Calcium” or “Excellent Source of Calcium.” They have at least 20 percent daily value of calcium or 200 mg, and sometimes up to 30 to 35 percent calcium.
Some foods are labeled “Contains Calcium,” “Provides Calcium” or “Good Source of Calcium.” They have at least 10 to 19 percent daily value of calcium or 100 to 190 mg.
Some foods say “Calcium Enriched,” “Calcium Fortified” or “Has More Calcium.” These foods have more than 10 percent daily value of calcium as compared to similar foods.
A complete daily multivitamin usually contains 75 to 100 mg of calcium. There may be some vitamins with higher levels of calcium, but they will not match the daily calcium requirements. If your child or teen does not get the calcium needed from foods or drinks, you need to talk with your health care provider, as a calcium supplement may be indicated.
The Right Amount of Vitamin D
The AAP has recommended that all infants, children and teens need at least 400 international units (IU) a day, starting days after birth — twice as much vitamin D as previously recommended. Infants who drink formula usually receive adequate amounts of vitamin D, but breastfed and partially breastfed infants need to receive vitamin D supplements of 400 IU until they can receive vitamin D from other sources such as fortified cereal or milk. Research has shown that there is an increase in children who have low levels of vitamin D. This may be due to the fact that soda has replaced milk, diets have become less healthy and children are spending less time outdoors and wearing sunblock. The body makes vitamin D when sunshine hits the skin.
Food labels are not required to list vitamin D content unless a food has been fortified with this vitamin. When checking labels, you may see vitamin D represented in micrograms (mcg). It is important to know that 1 mcg equals 40 IU, while 10 mcg equals 400 IU.
The best source of vitamin D is sunlight, but vitamin D is also found in milk, tuna, sardines and other fortified foods. The foods listed in the chart below are high in vitamin D.
Vitamin D is essential for building bones and absorbing calcium from food. In order for children and teens to get enough vitamin D, they need to have a healthy diet and spend some time in the sun. In addition, you should consider giving them a supplement that contains 400 IU. Milk can provide vitamin D and calcium, but it’s best to use a variety of sources to meet the daily requirements.
| FOOD ITEM HIGH IN VITAMIN D |
Serving Size |
IUs * |
| Cooked salmon |
3.5 oz |
360 |
| Cooked mackerel |
3.5 oz |
345 |
| Tuna fish, canned in oil |
3 oz |
200 |
| Sardines, canned in oil, drained |
1.75 oz |
250 |
| Milk, nonfat, reduced fat and whole, vitamin D-fortified |
1 cup |
100 |
| Margarine, fortified |
1 tbs |
60 |
| Ready-to-eat cereal, fortified |
1 cup |
40 |
| Egg, 1 whole (vitamin D is found in yolk) |
1 egg |
20 |
| Beef liver, cooked |
3.5 oz |
15 |
| Swiss cheese |
1 oz |
12 |
| * International Units |
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Sheryl Zang, Ed.D., FNP, CNS, is a Clinical Associate Professor, Downstate Medical Center College of Nursing. She is also in clinical practice on Long Island, specializing in weight management and eating disorders.
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