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Clinical Reference Systems: Pediatric Advisor 10.0

Milk and Calcium

Milk is good for most children. A few children cannot digest milk or are allergic to it and shouldn't drink it. Most children, though, can drink milk.

Milk provides important amounts of protein and it is many people's main source of calcium and vitamin D. Sometimes you may hear that milk is bad for people. These rumors are simply wrong. Until they get to adolescence, children need between 2 and 3 cups of milk every day.

If your child is drinking much more than 3 cups of milk a day, she may be filling up on milk and not leaving enough room for the other foods she needs. Then you might consider limiting the amount of milk she drinks and offering water for thirst.

If your child doesn't drink enough milk, she may not get the calcium she needs to develop strong bones. To help her get enough calcium, use more dairy products or calcium-rich foods in your cooking.

Amounts of Calcium in Foods

Children from age 1 to 3 years need 500 milligrams (mg) of calcium a day. Children 4 to 8 years old need 800 mg of calcium a day. Children 9 to 18 years need 1300 mg a day. The following chart shows how much calcium is in various foods.

FOOD                            AMOUNT         CALCIUM (mg) 
Dairy products: 
  Milk, liquid                  1 cup              300 
  Milk, powdered                1 Tbsp              60 
  Cheese, natural or 
    processed                   1 ounce            200 
  Cottage cheese                1/4 cup             60 
  Yogurt                        1 cup              300 
  Ice cream                     1/2 cup            110 
  Cream cheese                  1 Tbsp              10 

Meat and other protein sources: 
  Meat, poultry, fish           3 ounces      10 to 20 
  Canned fish with bones        3 ounces           250 
  Egg                           1 egg               30 
  Cooked dried beans            1/2 cup             70 
  Nuts and seeds                2 Tbsp        20 to 40 
  Peanut butter                 2 Tbsp              20 

Bread, cereal, pasta: 
  Bread                         1 slice             25 
  Biscuits, rolls               1 roll              25 
  Corn tortilla                 1 tortilla          60 
  Cooked and dry cereals        1 serving           15 
  Noodles, macaroni             1/2 cup             15 

Vegetables and fruits: 
  Vegetables, average           1/2 cup       20 to 40 
  Green, leafy vegetables, 
    average                     1/2 cup            100 
  Fruits, average               1/2 cup       20 to 40 
    orange juice                1/2 cup            160 

Ways to Include Calcium in the Diet

  1. Encourage your child to drink milk.

    You can make milk the only mealtime beverage except for water. You can drink it yourself. You can give your child a gentle reminder: "Don't forget about your milk."

    You mustn't insist, "You have to drink your milk." And you mustn't use leverage: "You have to drink your milk before you can have more spaghetti." Also, you shouldn't play games: "I bet I can drink my milk faster than you can." These tactics give children the clear message that they shouldn't like milk. Children reason, "If it's so good, how come they have to do all that to get me to drink it?"

    Most children go through a stage when they don't drink milk. For many, it is when they first are weaned from the nipple. Don't panic and put your child back on the bottle. Just wait. She will start to drink milk again.

    You can use the suggestions given below for including calcium in the diet by preparing special foods, but try to be low-key. The harder you work to make special foods, the more pressure you may put on your child to eat them. When children feel pressured to eat, they generally react by eating less.

See Eating Basics: Helping Your Child Eat Well.

  1. Use dairy products in different ways.

    Make fortified milk: Combine 2 cups of liquid milk and 1/3 cup of powdered milk. Cool in refrigerator before using. Substitute for regular milk. One cup of fortified milk contains the calcium and other nutrients of 1 and 1/2 cups of regular milk.

    Add flavorings to milk: strawberry, chocolate, soft drink powders. Make eggnog, cocoa, and milkshakes.

    Make a "smoothie": Blend milk with fruit to make a beverage much like a milkshake.

    Use milk in some cooking instead of water; for example, in cooked cereal, soups, and gravies.

    Use powdered milk when you bake. Add 2 tablespoons of powdered milk to each cup of flour. Store and use for all baking.

    Add powdered milk to other cooking:

    • Ground beef: Add 1/2 cup powdered milk for each pound of beef. Add water.
    • Casseroles: Add 2 tablespoons of powdered milk for each cup of casserole.
    • Vegetables: Make a cream sauce using powdered milk.

    Make desserts with fortified milk; for example, custard, pudding, rice pudding, pumpkin custard, and cheesecake.

    Use cheese in cooking; for example, macaroni and cheese, lasagna, tacos, grilled cheese sandwich, cheeseburgers, and pizza.

  2. Use vegetables high in calcium.

    Use beans and peas; for example, bean or split pea soup, chili, three-bean salad, pea-pickle-cheese salad, and kidney beans with cheese.

    Use leafy, green vegetables in salads, soups, and casseroles.

Calcium Supplements for Children Who Don't Eat Milk Products

You can give calcium supplements to make up for a lack of milk, but it is usually better to first try substituting other calcium-rich foods. There are different types of calcium supplements. Some are better absorbed by the body than others. Supplements may be tablets, wafers, or chewables. Supplements in the form of calcium lactate or calcium carbonate are reasonably well absorbed. Avoid bone meal and dolomite. They contain lead and other trace elements that are not good for your child.

The dosage varies. If you need to give your child several tablets, spread them throughout the day so your child's body can better absorb the calcium.

Calcium supplements come with or without vitamin D. Which you should use depends on whether your child is getting enough vitamin D from other sources. (The recommended daily allowance for vitamin D is 400 IU per day.)

Calcium-supplemented orange juice gives a lot of calcium. However, it does not contain vitamin D, nor does it give the protein that milk does. To get a whole day's supply of calcium, your child would need to drink 2 and 1/2 cups of calcium-supplemented orange juice a day.

Call Your Child's Physician During Office Hours If:

  • It looks like your child is getting less than 200 milligrams of calcium a day.
  • You suspect your child cannot digest milk or is allergic to it.

Written by Ellyn Satter, R.D., M.S.S.W., author of "Child of Mine: Feeding with Love and Good Sense," Bull Publishing, Palo Alto, CA.
Copyright 1999 Clinical Reference Systems