When my patients come in with their parents for the annual physical exam, one of the topics we always discuss is nutrition. Initially, I ask a general question and invite both parent and child to weigh in. I then ask some more specific questions, and one area that nearly always comes up as we go through their diet history in more detail is the fact that often kids do not have an adequate intake of calcium and vitamin D. One would think that kids would have an adequate consumption of dairy products to prevent deficiencies in these nutrients, but studies have shown that this is not always the case. Deficiencies in these nutrients and in particular vitamin D have been shown worldwide. (1)
Healthy Roles for Vitamin D and Calcium
Vitamin D and calcium are vital nutrients, performing important roles in the mineralization of bones. Lack of one or both can seriously impact bone health causing diseases such as
- Rickets, which is a weakening and deformity of bones
- Delayed growth
- Muscle weakness in children due to a deficiency of vitamin D
- Osteoporosis, which is a condition where bones are brittle and weak making them prone to fractures (2)
Vitamin D may also play other roles. Studies are examining its effect on the immune system and its possible involvement in preventing respiratory infections, ear infections, throat infections and other viral infections. It is the standard of care now to start all breastfeeding and partially breastfed infants on a vitamin D supplement shortly after birth as studies have shown that breast milk does not provide an adequate amount.
First Year and Beyond
Children tend to get enough calcium during the first year of life from breast milk. After the first year of life, cow’s milk is the nutrient-containing fluid of choice for children; however intake often starts to decline with milk being replaced by juice and water, neither of which contain calcium or vitamin D. As kids get older, soda is often added to their diets despite the fact that it has no nutritional value. Juice and soda have high sugar contents in general, which is another reason to avoid them. The American Academy of Pediatrics has made recommendations on the maximum amount of juice children should consume, suggesting 4-6 oz per day for children aged 4-6 years and up to 8 oz per day for children aged 7-18 years. (3) It should not have any added sugar and ideally be homemade using a juicer and from fresh fruits and vegetables.
I realize that as kids get older it can be more challenging to get enough of these nutrients in their diet. As a mom and pediatrician, I don’t recommend allowing your children to choose what they want to eat and drink. The minute that door opens, battles begin. I always served milk with meals so that is my sons’ normal. I also always kept cheese and Greek yogurt in the refrigerator as they are great with lunches or for snacks. Plus, they have the added benefit of containing protein, which will help satisfy hunger better than snacks that are high in sugar.
Kids typically need at least three servings of dairy products a day. Dairy products are the best way to provide both calcium and vitamin D, but for those who cannot tolerate them for various reasons, there are now acceptable options available. Another source of vitamin D is fish, which can safely be eaten two to three times a week without worrying about getting too much mercury. Fish is also a source of omega-3 fatty acids, which are known to improve neurodevelopmental outcomes in children and provide other health benefits as well. As an example, a 3.5 oz serving of wild salmon contains 600-1000 IU of vitamin D. The recommended daily amount is at least 400 IU per day in the first year of life and after that it is 600 IU per day. (4)
While it is best to obtain critical nutrients from a healthy diet, supplements are a safe and effective way to optimize your children’s vitamin and mineral intakes. While it is commonly known that vitamin D is synthesized in the skin from sun exposure, it is not a recommended way to increase vitamin D levels due to concerns around skin cancer and aging. Making sure your children have a diet rich in foods containing calcium and vitamin D will provide them with strong bones and potentially a healthier immune system. Start incorporating foods containing these nutrients early on and serve them daily along with a diet rich in healthy fats, proteins, fruits and vegetables. Good nutrition is the best and safest way to achieve proper growth and long-term health.
- Almeida, ACF et al. (2018) Do all infants need vitamin D supplementation? PLoS ONE 13(4)e0195368
- Saggese et al. Italian Journal of Pediatrics (2018) 44:51
- Maillot et al. Nutrition Journal (2018) 17:54
- Golden, Neville H. et al. Pediatrics. October 2014, 134 (4): e1229