From birth until about age 18 bones are forming and growing. Calcium in essential for this process. Breast milk and infant formulas are rich in calcium. As children grow, it is equally important that their diets remain calcium-rich. The calcium provided to bones early in life helps to determine how well they will hold up later in life.

Inadequate Calcium Intake is a Widespread Problem

In many dietary surveys, including the 1987-1988 Nationwide Food Consumption Survey, a significant percentage of children's diets provided less than the current recommended intake level for calcium. Public awareness of the dangers of high-fat diets further aggravates the problem. Many well-meaning parents serve their children fewer calciurn-rich dairy foods in and effort to avoid fat and calories.

NEW DATA FROM CALCIUM RESEARCHERS WORLDWIDE SHOWS
		Raising calcium intake in adolescents to 110% of recommended levels may prevent osteoporosis. A study conducted at Pennsylvania State University's College of Medicine in Hershey, Pa., demonstrated that increasing daily calcium intake from 90-110% of the recommended levels via supplementation resulted in significant increases in total body and spinal bone density in adolescent girls, possibly helping to provide protection against osteoporosis fracture in the future. (Lloyd, Tom, PhD, et al. Journal of the American Medical Association, 1993;270(7):841-844.)
		Calcium recommended intake levels may be too low. After an Indiana University School of Medicine study monitored the effects of calcium supplements in 45 pairs, of twins between the ages of six and 14 for three years, investigators proposed that the current recommended intake levels for calcium in children may need to be raised. One twin in each pair received either a 1000mg calcium supplement or placebo daily. The calcium treated group averaged about 1600 mg of calcium daily; the placebo treated siblings, about 900mg/day. At the end of the study, the twin given supplements had significantly denser bones than the placebo treated twin-even though the placebo group still consumed enough dietary calcium to meet the recommended intake levels requirements of 800 mg/day for children aged one - 10 years. ~ (Johnston CC, Miller JZ, Slemenda CW, et al, New England Journal of Medicine 1992;327:82-87.)
		Proper calcium balance requires higher intake. Another study from Davis Research Center in Columbus, Ohio, looked at data from 34 studies that measured calcium balance ---the relationship of calcium intake to calcium excreted by the body. In every age group, threshold values were higher than the recommended intake levels, suggesting that the body's need for calcium may be higher than recommended. (Matkovic V, Heaney RP, American Journal of Clinical Nutrition 1992;55:992-996.)
		High calcium intake may help prevent bone fractures. Research conducted in Majorca, Spain, found that schoolchildren between the ages of I I and 14 who lived in towns where the water supply was rich in calcium had a significantly lower incidence of bone fractures than children with a low-calcium water supply. The association was strongest among the youngest participants, indicating that calcium may be equally as critical to bone strength in the years preceding puberty as it is later in life. (Verd Vallispir S, Dominguez Sanchez J, Gonzalez Quintial M, et al Anales Espanoles De Pediatria 1992;37:461-465.)

SPECIAL CIRCUMSTANCES FOR EXTRA CALCIUM CONCERN
		Lactose intolerant children Lactose intolerance varies from person to person. Some patients may be able to tolerate fermented dairy products, and lactose-reduced milks and cheeses. Taking a lactase tablet before eating dairy products or adding enzyme drops to milk may also help. For patients who cannot tolerate any amount of dairy products, non-dairy sources of calcium are especially important. Calcium supplements may also be of importance in this population.
		Milk allergies A true milk allergy is much rarer than lactose intolerance, and requires a completely dairy-free diet. Most children outgrow their milk allergies. Patients who continue to be allergic should be encouraged to include non-dairy calcium sources in their diets. Calcium supplementation can be important in such cases.
		Eating disorders Nutrition is almost always compromised in eating disorders such as anorexia nervosa and bulimia nervosa. Anorexics and bulimics will probably need extensive dietary intervention that often includes calcium supplementation. In addition to other dietary modifications, patients should be encouraged to try fat-free and low-fat dairy products, as well as low-fat non-dairy calcium sources.
		Fractured and broken bones Children with broken bones need plenty of calcium to assist bone repair. Fracture patients who are in pain or despondent because of lack of mobility often experience appetite loss, and may lose calcium from bones due to lack of exercise. A high calcium intake-and exercise as soon as possible-is especially important. Calcium supplements may be appropriate for fracture patients who are not eating enough to get the recommended intake levels of calcium. Ask your healthcare professional about calcium needs following a fracture.
		Obesity Today, as many as one in four children is obese. These children and their parents should be encouraged to choose among the low-fat or fat-free dairy products now available. Calcium supplements may be a very important option as these are usually low-calorie and can help to ensure adequate calcium intake.

Calcium Supplements: When Diet Isn't Enough

Based on existing calcium recommended intake levels, millions of American children are calcium deficient. Even moderate deficiencies now can impact good health in later years.

Nutrition experts agree that the best source of calcium for children is food. However, for many children, achieving the recommended intake levels each day is difficult. In these cases, a calcium supplement, like TUMS or Oscal, will help children meet their daily calcium requirements. Pay special attention to children who are:

		Lactose intolerant or allergic to milk
		Picky eaters
		Teens who think milk is "kid stuff' and switch to sodas
		Overweight and/or on calorie restricted diets
		Children or teens with eating disorders

Read calcium supplement labels carefully, and remember that all supplements are not the same.

		A supplement must be easily absorbed into the bloodstream. A chewable calcium carbonate source such as TUMS or Oscal, is well absorbed.
		For young children who have difficulty swallowing pills, a pleasant-tasting chewable form of calcium may be preferable.
		Very young children may require that chewable tablets be broken-up or divided before ingesting. Be sure to give them small pieces they are comfortable chewing.
		Be sure, if you're using an antacid, that it is calcium-carbonate based and that it does not contain aluminum, which can actually increase calcium loss.

Combination Vitamin-Mineral Supplements

Even when fortified with extra calcium most vitamin/mineral supplement formulas rarely contain significant amounts of calcium. If a child's diet is significantly low in calcium, it may be preferable to use a seperate calcium supplement in addition to a vitamin mineral supplement.

Osteoporosis Prevention

A significant contribution to the prevention of osteoporosis can be made if children are encouraged to build strong bones that can serve as a calcium "bank" in later life.

Emphasizing a calcium-rich diet and bone-building exercises will help children start to develop healthy habits that will last them throughout their lifetime.

Helping Parents Learn About Calcium Nutrition

In most cases, parents whose children are not meeting the daily calcium requirements are eager for suggestions on how to get their children to eat more calcium-rich foods. Some important suggestions include:

		Don't try to force foods on children - it often backfires.
		Find calcium-rich foods children already like and serve them more frequently without pressure.
		Introduce new calcium-rich foods gradually.
		Don't serve too many full-fat dairy products. Low- fat and fat-free alternatives contain calcium too; however, parents should not go overboard in restricting fat; moderate amounts are critical for a child's healthy development.
		Parents whose children are lactose-intolerant or have milk allergies may need to consult a nutrition-health trained health professional.

Even very young children can understand that eating the right foods can help them "grow big and strong" and prevent them from getting sick. Ideas to help children and teens learn the importance of good eating habits include:

		Talk about eating at home, at school, in restaurants or cafeterias, or at playmates' houses- -and the calcium-rich options available.
		Provide sound nutritional information for older children and teens, who make independent eating decisions.
		Tell dieting teens about low-fat and fat-free dairy and other calcium sources.
		Explain that taking pleasant tasting supplements is a good way to get the additional calcium their bodies need.

Successful intervention to improve calcium intake requires:

		Assessing the amount of calcium in a child's diet
		Educating children and parents about the importance of lifelong calcium intake
		Providing strategies for adding calcium-rich foods
		And, when necessary, consider filling the calcium gap with calcium supplements.