Children

Why should I be concerned about building strong bones in my children?

Many people have compared the skeleton to a savings bank. Your child can deposit calcium into his or her bone bank account to use in later years when the body may need to take calcium from the skeleton. The best time for your child to build up his or her bone bank account is from childhood to young adulthood. Bones build at the fastest rate between the ages of 9 and 16 with peak bone mass reached in the mid 20's. Peak bone mass is when the skeleton is its strongest and contains the most bone mineral, especially calcium. There are actions that you can take to help your child reach his or her peak bone mass.

How much calcium should my child consume?

The calcium requirements change in the early years to reflect your growing child's needs, and the maximum requirements for calcium are between the ages of 9 and 18 when the bone bank is building up at the fastest rate.

*mg= milligrams

(Dietary Reference Intakes, National Academy of Science, 1997)

How can I make sure that my child gets enough calcium?

There are many easy ways to help your child get enough calcium in his or her diet. Children can get enough calcium by consuming three to four servings of calcium-rich foods daily.  It is a good idea to include a calcium source at each meal or snack. Calcium-rich foods include dairy products, calcium-rich non-dairy foods, and calcium-fortified foods.

Your child can get enough calcium in their diet, even if they are lactose intolerant, allergic to milk. or following a strict vegetarian diet. If they have lactose intolerance, you can provide enough calcium for your child by either giving them lactase enzyme replacement along with dairy products or by choosing dairy products with lactase enzyme added.

If your child is allergic to milk or is following a strict vegetarian diet, he/she can get enough calcium by consuming non-dairy beverages with calcium added (such as fortified rice milk, fortified soymilk, fortified citrus juice) as well as calcium rich non-dairy foods. Make sure to shake calcium fortified beverages before serving to prevent the calcium from settling on the bottom of the container.

How much vitamin D does my infant need to build strong bones?

It is important to talk to your infant's pediatrician about vitamin D needs. The American Academy of Pediatrics recommends that all infants have a minimum intake of 200 International Units (IU ) of vitamin D per day beginning during the first two months of life. This is important to prevent vitamin D deficiency (rickets) and to build strong bones.

The following information will help you be sure that your infant is getting the 200 IU of Vitamin D recommended each day:
-If your baby is breastfed, it is important to know that breastmilk is low in vitamin D. That is why all exclusively breastfed babies need to be given a supplement of at least 200 IU of vitamin D per day by two months of age.
- All formula is fortified with 100 IU of Vitamin D per 8 ounces. Infants need to consume at least 16 ounces of formula to get the recommended 200 IU of vitamin D per day. Until consuming at least 16 ounces of vitamin D fortified formula, a vitamin D supplement of at least 200 IU per day is recommended for bottlefed infants.
- A daily multivitamin supplement containing at least 200 IU of vitamin D is often prescribed by medical providers when supplemental vitamin D is needed. A supplement is needed until breastfed babies are weaned to consume at least 16 ounces of vitamin D fortified formula (or if over 12 months if weaned to consume at least 16 ounces of vitamin D fortitied cow's milk).

How can I be sure that my child is getting enough vitamin D?

During childhood and adolescence, the American Academy of Pediatrics and the National Academy of Sciences recommend at least 200 IU of vitamin D per day.  Milk is an excellent source of vitamin D recommended by the American Academy of Pediatrics; each 8-ounce cup provides 100 IU of vitamin D along with other bone-building nutrients. To get enough vitamin D and calcium, the Academy recommends 2 cups (to provide a total of 16 ounces per day) of lowfat or fat-free milk for children aged 2 to 8 and 3 cups (to provide a total of 24 ounces) per day of lowfat or fat-fee milk for youth aged 9 to 18. Other sources of vitamin D include vitamin D fortified orange juice (100IU per 8 ounce cup) and multivitamins (look for those containing vitamin D3 or cholecalciferol).

Is exercise important for my child's bone health?

Regular physical activity is absolutely necessary in order for your child to build strong bones. It is known that the greatest impact of exercise on the skeleton occurs in children before puberty but the benefits of exercise continue throughout life. We do know that weight-bearing exercise places physical stress on the body, and that bones like muscles respond to stress by becoming bigger and stronger. However, like muscles, bones weaken if not used. Therefore, it is important that you encourage your child to be active for at least 60 minutes each day. Exercise that involves jumping may be a particularly effective way to increase your child's bone mass.

The importance of safety for your child's bone health

It is important that you keep your child's bones safe. Safety strategies to protect bones are important for children of all ages. It is imperative for all children to protect their bones and overall health by wearing seatbelts in any moving vehicle and by using appropriate protective equipment when participating in sports.

What is the SNEAKER© Project?

The SNEAKER© Project is a nutrition education program designed to provide culturally sensitive information to English, Spanish, and Chinese speaking children and their families in New York City.

In 2003, the New York State Attorney General’s Office awarded Hospital for Special Surgery, the Metro New York NYSOPEP Regional Center, the resources to implement a program focused on “the improvement of the health and/or nutrition of New York State citizens and/or the advancement of nutritional, dietary or agricultural science."

The Metro New York NYSOPEP Regional Center has conducted several SNEAKER© Programs at elementary schools, community centers and not-for-profit organizations, reaching over 2,000 New York City Children. Throughout it all, the mission of the SNEAKER© Project was to reinforce the following nutrition information:

1. To appreciate the importance of calcium intake and the various forms of calcium
   
   
2. To understand the value of consuming whole grain and other high fiber foods
   
   
3. To recognize the perceived versus real amounts of sugar hidden in certain foods and beverages
   
   
4. To learn the definition of portion control and understand portion sizes
   
   
5. To identify healthy food options for the school cafeteria, fast food restaurants and home
   

The Sneaker Project at Hospital for Special Surgery invites you and your child to visit the fun, interactive nutrition education website by clicking on the following link:
www.hss.edu/SNEAKER