Monday, December 11, 2006

Calcium Requirement

Dear Lisa,

What vitamin and calcium doses are appropriate for a 14 month old baby? Baby absolutely refuses to drink milk in any form. Used to be breastfed.

“Baby Needs Calcium”

“Baby Needs Calcium”,

It is very common for an infant once weaned from the breast to refuse whole milk. In some cases, this refusal is temporary and a parent just needs to be patient and wait for their child to come around. In the mean time it is very important that a child receives the correct amount of calcium and Vitamin D to ensure proper bone growth.

A child from 1 to 3 years old needs 500mg of calcium per day which can be found in two cups of whole milk. If your child refuses to drink milk then other foods containing calcium need to be given. The good thing is that many products have been reformulated to contain extra calcium and can be found in the supermarket. Choosing products with extra calcium will ensure that your child receives the correct amount of calcium per day.

The types of calcium fortified foods that a 14 month old may eat include; yogurt, slices of American cheese, cheddar cheese (1 oz = 213 mg calcium), a grilled cheese sandwich, cottage cheese(½ cup = 115mg calcium), ricotta cheese mixed in pasta, sherbet, pudding, broccoli (½ cup = 68 mg calcium), and boxed fortified cereal with milk. Toddlers also tend to like juice and can receive the calcium that is required by drinking orange juice or other juices with added calcium.

Feeding toddlers is a very difficult task. Besides being very messy eaters they tend to be very picky too. One day they may eat a lot and then they can go through the next couple of days only picking at a small amount of food. The most important thing to remember is, if a toddler refuses a new food, do not give up. It is common for toddlers to refuse a new food many times before they actually eat it. There is a greater chance that a child will accept a certain food if they are exposed to it multiple times.(1) Therefore if a child repeatedly refuses a food, try it again at a latter date.

Milk contains the most amount of calcium per serving; 288 mg per cup. Therefore it may be easier to achieve your goal by adding milk to the food that your child already eats. By adding a little milk to your child’s diet throughout the day, your child should not notice the difference and will not have the opportunity to refuse it. This is also a good approach because calcium is best absorbed if spread out evenly during the day as opposed giving the recommended amount all at once.(2)

Milk can be added to oatmeal, farina, pastina, mashed potatoes, scrambled eggs and pasta. When feeding a toddler a hot meal, it is also a good idea to splash milk into the dish of warm food. This doesn’t only cool the meal down, but adds some calcium and Vitamin D to their diet.

Besides calcium, Vitamin D is needed for proper bone growth and maintenance. The correct amount of Vitamin D is needed in order for calcium to be absorbed. Vitamin D is essential for the transport of the calcium obtained from food across the lining of the intestines to the parts of the body where it is needed. Therefore, it is important to choose foods for your child that contain calcium and Vitamin D.(2) Vitamin D can be found in egg yolks, fish liver oils and milk.

Exposure to sunlight for at least 15 minutes per day is also necessary for the proper absorption of Calcium and Vitamin D. Sunlight converts Vitamin D in the body into a form that can be absorbed. Children who do not get enough sun exposure are at a risk for developing Vitamin D deficiency and rickets.(3) Vitamin D deficiency is prominent world wide and is more prominent in girls of low socioeconomic status and those whose cultural norms require them to wear veils.(4) Other risk factors for Vitamin D deficiency include exclusively breastfed infants(vitamin D is deficient in human milk), dark skin pigmentation, sunscreen use and atmospheric conditions. (1)

Most Doctors and Nurse Practitioners agree that the vitamin, Poly-vi-sol contains the proper amount of vitamins that a child requires. This vitamin comes in a liquid form for young infants and toddlers and in a chewable form for older children. Poly-vi-flor contains the same vitamins as Poly-vi-sol except it also contains Fluoride. Children who do not have Fluoride in their drinking water need vitamins with Fluoride.

Sometimes, the best way a parent can convince their child to eat healthy foods is to eat healthy foods themselves. It has been found that food preferences are influenced early by parental eating habits, and tend to remain fairly constant into adulthood.(5) So, what better way to encourage your child to drink milk then to sit in from of her and drink a tall glass of milk with a great big smile on your face.

For More Information about calcium needs and childhood nutritional requirements log onto:

American Dietetic Association

(1)Grassia T. Pediatricians: Discuss healthy nutrition during well child checks. Infectious Diseases in Children. 2006. August:45.
(2)American Dietetic Association. Calcium and Vitamin D: Essential elements for Bone Health. Available at: Accessed Dec 2006.
(3)Tortora G, Anagnostakos N. Principles of Anatomy and Physiology. 4th ed. Sao Paulo, Sidney:Biological Sciences Textbooks, Inc. 1984:132.
(4)El-Haji Fuleihan G, Nabulsi M, Tamim H. Effect of vitamin D replacement on musculoskeletal parameters in school children: a randomized controlled trial. J Clin Endocrinol Metab. 2006;91:405-412.
(5)Strauss R. Childhood obesity. Curr Problems Pediatr. 1999;29(1)1-29.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice For Parents with Toddlers

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