For children aged 4 to 8 years, 800mg of calcium/day is recommended, whereas for children and adolescents aged 9 through 18 years, 1,300 mg of calcium/day is recommended (3). This higher calcium recommendation coincides with peak calcium accretion rates in bone which occur at an average age of 12.5 years for girls and 14 years for boys (8,9).
For most children over 8 years of age and adolescents in the U.S., calcium intakes are below daily recommended levels (4,8,10,11). According to data from the National Health and Nutrition Examination Survey (NHANES) 2001-2002, only 6% of girls and 28% of boys aged 9 to 13 years and only 9% of girls and 31% of boys aged 14 to 18 years have calcium intakes greater than recommended (4). Not only does dietary calcium intake decline with age, but at all ages females’ calcium intake is much lower than that of males (4,10).
In addition to calcium, bone health depends on an adequate vitamin D status, which increases calcium absorption (1,3,7,8). The current dietary recommendation for vitamin D for children and adolescents is 200 I.U. per day (3,12ere have been several reports of low vitamin D status among U.S. adolescents, especially those who are not regularly exposed to sunlight and/or do not consume at least 2 cups/day of vitamin-D fortified milk (12-15).
Inadequate consumption of milk and other dairy foods contributes to low dietary intake of calcium (and vitamin D) (1,2,10,16). Dairy foods are the major source of dietary calcium, providing 72% of the calcium in the U.S. food supply (17). On average, adolescent girls aged 12 to 19 years are consuming only 1.7 servings/day from the Milk Group, while similar aged boys are consuming 2.4 servings/day (5). Without including adequate amounts of dairy foods (i.e., at least 3 servings/day) in the diet, it is improbable that daily recommended dietary intakes of calcium will be met (1,2).
Many factors influence children’s and adolescents’ dairy intake, each of which needs to be considered in efforts to promote adequate calcium intake (8,10). A preoccupation with being thin or the misperception that all dairy foods are fattening can limit intake of these foods (8,10). The 2005 Dietary Guidelines for Americans (7) advises adults and children to not avoid milk and milk products because of concerns about weight gain. Also, the AAP report points out that “children, adolescents, and parents may not be aware that low-fat milk contains at least as much calcium as whole milk” (8).
Because of the family’s influence on children’s and adolescents’ diets, family members are encouraged to serve as role models by consuming and serving milk and other dairy foods themselves.
Replacement of milk intake by soft drinks and fruit juices and/or fruit drinks may contribute to adolescents’ low calcium intakes (8-10,18-20). This concern was expressed in the AAP’s policy statements restricting soft drinks in schools (19) and limiting juice intake in children (20). Lactose maldigestion, which is more common in children of African, American Indian, and Asian descent than in white children, may lead to restriction of dairy and calcium intake (8,10). However, many children with lactose maldigestion can consume dairy products without discomfort by drinking smaller amounts of milk (e.g., 1 cup) especially with meals, eating aged cheeses (e.g., Cheddar, Swiss), or consuming yogurt with live active cultures (7,21,22). Lactose-free and low lactose milks are other options to encourage children to meet the recommended 3 servings/day of dairy foods. In a new report on lactose intolerance, the AAP recommends that children and adolescents with lactose intolerance consume dairy foods, as suggested above, in order to obtain enough calcium, vitamin D, protein, and other nutrients essential for bone health and growth (21).
Parents, through role modeling, expectations and attitudes, can influence their children’s dairy and calcium intake (8,23-25). Researchers have found that mothers who drink milk more often tend to have young daughters who drink milk frequently and consume fewer soft drinks (23). A study of 192 girls followed from ages 5 to 9 and their mothers found that, at age 9, the girls who consumed recommended dietary intakes of calcium drank twice the amount of milk, had slightly higher bone mineral density, and had mothers who drank and served milk more frequently than girls with low calcium intakes (24). Some recent studies show that breakfast consumption improves children’s and adolescents’ calcium intake (26,27).
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