Calcium Requirements in Children

Tips from the HSS Pediatric Musculoskeletal Department


H. Susan Cha, MD

H. Susan Cha, MD

Assistant Attending Pediatrician, Hospital for Special Surgery
Assistant Professor of Pediatrics, Weill Cornell Medical College
Assistant Professor of Pediatrics, NewYork-Presbyterian Hospital

Stephanie L. Perlman, MD

Stephanie L. Perlman, MD

Assistant Attending Physician, Hospital for Special Surgery
Assistant Professor of Pediatrics, Weill Cornell Medical College
Assistant Attending Physician, New York-Presbyterian Hospital

What is calcium?

Calcium is a mineral that is mostly present in bones, and having enough calcium to meet daily requirements is necessary for the development and maintenance of strong bones. Adequate calcium intake is necessary to maximize peak bone mass and to minimize both the risk of fractures in adolescence and the development of osteoporosis in adulthood.

How can I get enough calcium?

Milk and other dairy foods provide 73% of the calcium available in the nation’s food supply and are the major dietary source of calcium for U.S. children. The low intake of milk and other dairy foods by many children and adolescents is the primary reason for their low calcium intake.

Calcium can be obtained by many foods. Look for foods that say “High in Calcium,” “Rich in Calcium,” or “Excellent Source of Calcium,” in contrast to “Calcium Enriched," “Calcium-Fortified,” or “More Calcium.” Calcium is best absorbed if consumed throughout the day. Generally, our bodies can only absorb 500mg of elemental calcium at a time.

How much Vitamin D do I need?

Vitamin D is critical to the absorption of calcium from the gastrointestinal tract and in bone formation. To prevent rickets and vitamin D deficiency, children will need a supplement with 400IU of Vitamin D each day if they are exclusively breastfed or not drinking at least 500mL (17 ounces) of Vitamin D fortified milk or infant formula. Older children and teens who do not get regular sunlight exposure and who do not drink at least 500mL of Vitamin D fortified milk each day will also need a supplement.

Conditions that predispose to bone loss and weakness: anti-seizure medications, inflammatory bowel disease, diabetes, prolonged steroid use, eating disorders, and thyroid disease.

Fact #1: Even though parents understand the importance of their children getting enough calcium, only about ½ of younger children and even fewer teens get enough calcium in their diet.

Fact #2: Multivitamins do not contain much calcium. So, if calcium intake is too low by food intake, over the counter calcium supplements is needed (Calcium Carbonate or Calcium Citrate). Make sure that you obtain adequate elemental calcium, which is the amount of calcium available for absorption by the gastrointestinal tract.

Fact #3: A high calcium intake alone is a rare cause of high calcium in the blood, a condition known as hypercalcemia.

Fact #4: Weight bearing exercise regularly will help maintain bone density, agility, and strength, decreasing the risk of fractures.


For the following chart, keep in mind that most foods represent calcium as a percentage of an adult daily value of 1000 milligrams. As a result, you can find out how much calcium is in a product by adding a zero to the end of the percentage. For example, 27%, as labeled on the package, would equal 270mg of calcium. While the daily recommended value is much less for children, you can still use this trick to calculate the volume of calcium in the product for the uses of the table below.

Daily Calcium Requirements

 Birth - 6 months  6 - 12 months  1 - 3 years  4 - 8 years  9 - 18 years  19 - 50 years
 210mg  270mg  500mg  800mg  1300mg  1000mg

Pregnant or Lactating Mothers 18 and under: 1300mg daily
Pregnant or Lactating Mothers 18 and over: 1000mg daily

Avoid more than 2500mg of calcium daily.

In addition to milk, there are a variety of foods that contain calcium and can help children get sufficient levels of calcium in their daily diet. Some examples include:

 Food  Examples
 Dairy Foods  Milk, yogurt, cheese
 Leafy green vegetables  Broccoli, kale, spinach
 Fruits  Oranges
 Beans and peas  Tofu, peanuts, peas, black beans, baked beans
 Fish  Salmon, sardines
 Miscellaneous  Sesame seeds, blackstrap molasses, corn tortillas, almonds, brown sugar

Guidelines based on American Academy of Pediatrics (AAP) 2008 recommendations

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