Four Seasons Pediatrics

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Vitamin D and Calcium in Children

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Common wisdom says that if you’re child drinks milk and plays outside, he’s getting enough vitamin D, right? Surprisingly, not necessarily.  ​We know more about vitamin D than we did even five years ago. Because of lifestyle changes and sunscreen usage, the majority of the population shows signs of vitamin D deficiency.  Vitamin D helps ensure the body absorbs and retains calcium and phosphorus, both critical for building bone. A vitamin D deficiency can lead to rickets, a bone-softening disease that continues to be reported in the United States mostly in children in the first two years of life.   Vitamin D deficiency also increases the risk of bone fractures in older children, teens, and adults.  Vitamin D is measured in International Units (IU).

The increase in the recommended amount of vitamin D children need each day is a result of new evidence showing its life-long health benefits. Supplementation is important, because most children will not get enough vitamin D through diet alone.

For a list of foods with vitamin D, click here.   See the products for supplementing Vitamin D below – along with the links posted.

What are the current recommendations for Vitamin D?

1. Breastfed infants and partially breastfed infants should be supplemented with 400 IU/day of Vitamin D until your infant is weaned to at least 18-20 ounces of vitamin fortified formula.  Supplement  with 400 IU when switching to milk at 12 months of age.  When switching to milk, we no longer recommend switching to whole milk.  All children should be on nonfat milk at age 2, and most should be on nonfat milk starting at age 1 when they switch.  The amount of Vitamin D is the same in all types of milk.  Higher fat does not confer advantages, in fact there are disadvantages.   

2. Older children (older than 12 months of age should receive 400-600 IU per day of vitamin D. 

3. Adolescents who do not obtain 600 IU of vitamin D per day through diet and vitamin D fortified foods (such as cereal and eggs) should receive a vitamin D supplement of 600 IU per day.

Here are some of the choices to supplement Vitamin D:

  • Enfamil D Vi Sol – vitamins – contains vitamin D.  Contains 50 doses.  1 ml contains 400 IU of vitamin D
  • Bio-D Mulsion – 1 drop contains 400 IU of vitamin D.  Contains 750 doses.  Just be careful using, there is a risk of incorrect dosing since this is very concentrated.  It is also inexpensive
  • Vitamin D chewables – 1 gummi contains 600 IU
  • Vitamin D capsules – 600 IU per capsule
Natural Sources of Vitamin D - AAP Chart

What are the current recommendations for calcium?

How much calcium your body needs varies according to age. You need the most calcium between 9 and 18 years of age.

The American Academy of Pediatrics recommends the following daily intake of calcium:

AgeCalcium Need (mg per day) Servings of Milk to Meet Need
4–8 years8003 servings
9–18 years1,3004 servings
9–50 years1,0003–4 servings

How to get calcium

The best way to get the calcium that you need is by eating and drinking foods that naturally contain calcium. Many foods contain some calcium, but the best sources include the following:

  • Low-fat milk, yogurt, and other milk products are generally super sources of calcium.
  • Flavored milks, such as chocolate or strawberry, have as much calcium as plain milk but may have more calories.
  • Dark green, leafy vegetables such as kale and turnip greens are low in calories and high in calcium. However, spinach is not a good source of calcium.
  • Broccoli, tofu, chickpeas, lentils, split peas, and canned salmon and sardines (and other fish with bones) also are good sources of calcium.
  • Calcium-fortified juices and cereals can help boost the calcium in your diet, but limit yourself to 8 to 12 ounces (1½ cups) of juice a day.

What decreases calcium

The following can hurt your bone health:

  • Drinking a lot of soda (pop or soft drinks)—Studies show that this may make you more prone to bone fractures. This may be because sodas often take the place of milk or other calcium-rich drinks. Cola-type sodas also contain phosphorus, which may interfere with how your body handles calcium.
  • Certain diets—Some diets may not provide enough calcium, such as a vegetarian diet that excludes dairy products. Before you start any diet, check with your pediatrician to make sure it includes enough calcium.
  • Caffeine, alcohol, and tobacco—All of these can cause you to lose calcium from your bones.
  • Certain medicines and diseases—Some medicines and kidney and intestinal diseases can cause you to lose calcium from your bones. Ask your pediatrician if any of the medicine you are taking affects your bones and what you can do to protect them.

How to get more calcium

There are many ways to get more calcium, such as

  • Choose milk or smoothies instead of soda at restaurants or school cafeterias.
  • Boost the calcium in salads with beans (such as garbanzo or kidney), cheese, broccoli, almonds, or tofu.
  • Choose yogurt as a light meal or snack.
  • Create special drinks with milk. Add flavorings. Make shakes or smoothies.
  • Use low-fat yogurt on its own or with fresh fruit. Add it to pancakes or waffles, shakes, salad dressings, dips, and sauces.
  • Try calcium-rich foods that may be new to you and your family.
  • Try calcium-fortified juice and calcium-fortified waffles or cereal for breakfast.
  • When possible, choose sources of calcium that are either low in fat or have no fat at all.
  • Or make trade-offs in your food choices. For example, if you go for a thick, chocolate milk shake, skip the French fries. (Removing fat from a food does not take away calcium.)

If you make the right choices, the foods you eat or the things you drink can provide the calcium you need.

Calcium Content of Foods:

Food Amount Calcium (mg)
Milk (skim, low fat, whole) 1 cup 300
Buttermilk 1 cup 300
Cottage Cheese .5 cup 65
Ice Cream or Ice Milk .5 cup 100
Sour Cream, cultured 1 cup 250
Soy Milk, calcium fortified 1 cup 200 to 400
Yogurt 1 cup 450
Yogurt drink 12 oz 300
Carnation Instant Breakfast 1 packet 250
Hot Cocoa, calcium fortified 1 packet 320
Nonfat dry milk powder 5 Tbsp 300
Brie Cheese 1 oz 50
Hard Cheese (cheddar, jack) 1 oz 200
Mozzarella 1 oz 200
Parmesan Cheese 1 Tbsp 70
Swiss or Gruyere 1 oz 270


Acorn squash, cooked 1 cup 90
Arugula, raw 1 cup 125
Bok Choy, raw 1 cup 40
Broccoli, cooked 1 cup 180
Chard or Okra, cooked 1 cup 100
Chicory (curly endive), raw 1 cup 40
Collard greens 1 cup 50
Corn, brine packed 1 cup 10
Dandelion greens, raw 1 cup 80
Kale, raw 1 cup 55
Kelp or Kombe 1 cup 60
Mustard greens 1 cup 40
Spinach, cooked 1 cup 240
Turnip greens, raw 1 cup 80


Figs, dried, uncooked 1 cup 300
Kiwi, raw 1 cup 50
Orange juice, calcium fortified 8 oz 300
Orange juice, from concentrate 1 cup 20


Garbanzo Beans, cooked 1 cup 80
Legumes, general, cooked .5 cup 15 to 50
Pinto Beans, cooked 1 cup 75
Soybeans, boiled .5 cup 100
Temphe .5 cup 75
Tofu, firm, calcium set 4 oz 250 to 750
Tofu, soft regular 4 oz 120 to 390
White Beans, cooked .5 cup 70


Cereals (calcium fortified) .5 to 1 cup 250 to 1000
Amaranth, cooked .5 cup 135
Bread, calcium fortified 1 slice 150 to 200
Brown rice, long grain, raw 1 cup 50
Oatmeal, instant 1 package 100 to 150
Tortillas, corn 2 85

Nuts and Seeds

Almonds, toasted unblanched 1 oz 80
Sesame seeds, whole roasted 1 oz 280
Sesame tahini 1 oz (2 Tbsp) 130
Sunflower seeds, dried 1 oz 50


Mackerel, canned 3 oz 250
Salmon, canned, with bones 3 oz 170 to 210
Sardines 3 oz 370


Molasses, blackstrap 1 Tbsp 135
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