Most older children and adolescents in the United States currently do not achieve the recommended intake of calcium. Maintaining adequate calcium intake during childhood and adolescence is necessary for the development of peak bone mass, which may be important in reducing the risk of fractures and osteoporosis later in life. Optimal calcium intake is especially relevant during adolescence, when most bone mineral accretion occurs. Because of the influence of the family's diet on the diet of children and adolescents, adequate calcium intake by all members of the family is important. Assessment of calcium intake can be performed in the physician's office. A well-rounded diet including low-fat dairy products, fruits, and vegetables and appropriate physical activity are important for achieving good bone health. Establishing these practices in childhood is important so that they will be followed throughout the life span.
OVERVIEW AND BACKGROUNDNational survey data consistently show that most US children older than 8 years fail to achieve the recommended intake of calcium [1][2][3][4] (Fig 1). Maintaining adequate calcium intake during childhood and adolescence is necessary for the attainment of peak bone mass, which may be important in reducing the risk of fractures and osteoporosis later in life. 3,4 Approximately 99% of total body calcium is found in the skeleton, with only small amounts found in the plasma and extravascular fluid. The primary need for dietary calcium is for bone mineral deposition. Hypocalcemia and calcium-deficiency rickets are uncommon in healthy infants, children, and adolescents. Overall calcium homeostasis is maintained by the actions of calcium-regulating hormones, which most notably include parathyroid hormone, calcitonin, and 1,25-dihydroxyvitamin D. Calcium is absorbed in the intestine by both passive and active processes, the active process being more important in situations in which dietary calcium intakes are suboptimal. The ability to respond to low calcium intakes is limited, however, and active absorption does not compensate for low intake. The active process requires vitamin D, which emphasizes the fact that good bone health requires satisfactory intakes of both calcium and vitamin D. The current recommended adequate vitamin D intake for all infants (including those who are breastfeeding), children, and adolescents is 200 IU per day (5.0 g per day). 4,5 Optimizing calcium intake is particularly important during adolescence. Peak calcium-accretion rate is attained at an average of 12.5 years of age in girls and All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.