“Doctor, I was recently told that my bones are lacking in Calcium because I didn’t take it sufficiently when I was growing up. In our times, we didn’t know all this. I don’t want my Rehaan to suffer from the same fate. Can I start him on calcium supplements from now itself?” Rehaan’s mother’s concerns were justified. So how do you know – does your child need calcium supplements?

Why is Calcium so important for kids?

Calcium is required to make and maintain strong bones and teeth. 90% of our bone strength is achieved before the age of 18 in girls and 20 in boys. This is called as peak bone mass. Optimal peak bone mass is important to reduce the risk of osteoporosis (brittle bones) later in life. Hence adequate calcium must be consumed especially by children and teenagers.

Poor calcium intake in childhood can contribute to a disease called rickets. Poor calcium intake and hence lower bone mass puts children at risk for fractures.

How much Calcium do kids need?

According to the Indian Council of Medical Research, in the first year of life, babies need 500 mg of calcium per day. From ages 1 to 9 years, the daily requirement of calcium goes up to 600 mg. Above 10 years of age, boys and girls require 800 mg calcium per day. It is recommended to give adolescents higher quantities so that their bones can achieve high peak bone mass.

Does my child need Calcium Supplements?

In newborn babies who have sufficient vitamin D levels and are exclusively on breast milk, calcium deficiency is unlikely to occur.  Hence calcium supplementation is required only if intake is inadequate through diet.

So if calcium is so important, the more the merrier right? Why not give them calcium supplements? Researchers have found that if a child is receiving his daily requirement of calcium through food, giving more will not help.

A lot of foods are a rich source of calcium (mentioned below). Calcium obtained from diet is better absorbed than the calcium from supplements.

Some children are lactose intolerant or have illnesses which do not allow their daily calcium needs to be met. So if your kid’s medical condition does not permit or if s/he refuses to consume adequate amounts of calcium through dietary sources, calcium supplements may be given. Your child bone doctor will advise you on the supplements needed for your child.

Which foods are rich in calcium?

Here are some good sources of calcium (yes, there are options in addition to milk!). The calcium content mentioned below is per 100 gm edible portion:

• Green leafy vegetables like curry leaves (kadhi patta), amaranth (chauli), cauliflower greens, knol khol leaves (navalagol / gothagobhee): 500 – 800 mg. Agathi (common in South India) is a rich source providing 1130 mg calcium. Colocasia leaves (Arbi ke patte) are one of the richest sources providing about 1540 mg of calcium.
• Cereals and legumes like ragi (nachani), whole bengal gram (chana), whole horse gram, rajmah and soyabean contain 200 – 340 mg of calcium.
• Nuts and oilseeds like dry coconut, almonds, mustard seeds and sunflower seeds contain about 130 – 490 mg while cumin seeds contain a good 1080 mg of calcium.
• Fishes like katla, mrigal, pran, bacha and rohu have about 320 – 650 mg of calcium.
• Milk (cow’s/goat’s/ buffalo’s) and curds contain about 120 – 210 mg.  Cheese, khoa, skimmed/ whole milk powder contain 790 – 1370 mg of calcium. The Indian Academy of Paediatrics recommend that in children above one year of age, calcium may be obtained from 2-3 servings of milk and milk products per day.

So if your daughter is seven years old and has one portion of ragi for breakfast and chauli sabzi in her lunch, she would have obtained the necessary calcium for that day. The same may however leave your adolescent son having a deficit of calcium in his diet that day.

A word on Vitamin D

Vitamin D assists our body in absorbing calcium. Our bodies make most of the required Vitamin D on its own, provided there is adequate exposure to sunlight. A small percentage (less than 10%) is obtained from foods like eggs, cod liver oil, certain fish (bangda, rawas), cheese etc. Since a lot of Indian kids are spending time indoors and since our foods are not always fortified with Vitamin D, supplementation may be required in all children and adolescents.

Thus, as far as possible, your child’s daily calcium requirement is best met through dietary sources. If your child’s diet cannot provide the required calcium, it is best to consult your child bone doctor and ask if supplementation is required.

Dr. Mandar Agashe (MS Ortho) is a child bone doctor in Mumbai. If you have any queries about your child’s calcium requirement, do get in touch with Dr. Mandar Agashe at Agashe Hospital. To book an appointment, call 9867539883 today.