New Guidelines for Bone Health in Children and Adolescents

Vitamin D, calcium and exercise key to bone health in kids, says AAP report

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Once thought to simply be a part of aging, osteoporosis may have roots in bone mass acquired in childhood. That's why the American Academy of Pediatrics (AAP) recently released a report that looked at bone health in childhood and adolescence.

In addition to providing guidelines for calcium and vitamin D, the report also called for kids to exercise to strengthen their bones.

The authors of the report did not recommend using calcium or vitamin D supplements without a doctor's recommendation.

According to the report — written by Neville H. Golden, MD, and Steven A. Abrams, MD, with the AAP's Committee on Nutrition — osteoporosis risk for later in life is often established during childhood. The condition raises the risk of bone fractures and breaks because it makes the bones brittle. Calcium or vitamin D deficiencies can raise the risk for this disease.

Calcium is key to bone growth and strength. But it can't work well without vitamin D, which helps the body absorb it.

Hannah Chow-Johnson, MD, a pediatrician at Loyola University Health System and assistant professor at Loyola University Chicago Stritch School of Medicine, told dailyRx News what she recommends for children in her practice.

"We recommend 14-15 ounces daily of milk for children over the age of 1 in order to meet the recommended daily allowances of calcium and vitamin D. Also, look at labels for vitamin D fortified foods (often in breads and cereals)," Dr. Chow-Johnson said.

"For breastfed children, they must have daily vitamin D in order to get enough for their children's needs," she said.

"For calcium, children who cannot/will not drink milk can eat cheese, yogurt, ice cream (although in limited amounts), calcium-enriched orange juice, green vegetables (like kale and broccoli — every child's favorites), or use vitamins with calcium," she said. "Also, milk can be used in cooking or as an additive in things like shakes. Powdered milk is an alternative."

According to the authors of the AAP report, "Without vitamin D, only 10 percent to 15 percent of dietary calcium is absorbed."

Dr. Chow-Johnson warned, however, that there is such thing as too much vitamin D.

"Vitamin D is a vitamin that can be given in excess," she said. "Over 10 times the RDA (recommended daily allowance) is excessive and can cause vitamin D toxicity. Signs of toxicity include nausea, vomiting, poor appetite, constipation, weakness and weight loss. Excess vitamin D can also damage the kidneys."

She also warned that too much calcium can cause problems, too. "Excess calcium is linked to a higher risk of developing kidney stones, although kidney stones are rare in children, even with those who drink a lot of calcium (40 or more ounces)," she explained.

Dr. Chow-Johnson outlined the recommended daily allowances of vitamin D and calcium. For children 12 months old or younger, the recommended daily amount of vitamin D is 400 IU, Dr. Chow-Johnson explained. After that, the recommended amount is 600 IU. The recommended daily allowance of calcium is 200 milligrams for children younger than 6 months, 260 milligrams for those aged 7 to 12 months, 700 milligrams for those aged 1 to 3 years, 1,000 milligrams for those aged 4 to 8 years and 1,300 milligrams for those aged 9 to 18 years.

Drs. Golden and Abrams offered strategies that doctors should use to improve bone health in children and teens to reduce their risk for bone disease later in life. 

Although the authors said doctors should encourage kids to eat more foods that contain calcium and vitamin D — like milk, yogurt and cheese — they did not call for universal screening for deficiencies in kids.

"Evidence is insufficient to recommend universal screening for vitamin D deficiency," the authors wrote. "The Endocrine Society recommends that 'at-risk individuals' should be screened."

Those at risk include children who are obese, black or Hispanic, the authors noted. Also, kids who break bones from minor falls and other low-impact injuries should be screened.

For infants, guidelines remain the same — their diets should consist mostly of breast milk or infant formula for the first year of life, the AAP said. 

The AAP report also said doctors should tell children to engage in weight-bearing activities like walking, dancing and running — all known to increase bone density.

The report was published online Sept. 29 in Pediatrics.

The authors disclosed no funding sources or conflicts of interest. 

Review Date: 
September 26, 2014
Last Updated:
October 8, 2014