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Health Services: Wellness - Q and A


Photograph of a young girl drinking her milk at a school lunch program. USDA
USDA School Lunch Photograph 2003

Why is childhood such an important time for bone development?

Bones are the framework for your child's growing body. Bones are living tissues that changes constantly, with bits of old bone being removed and replaced by new bone. You can think of bone as a bank account, where (with your help) your kids make "deposits" and "withdrawals" of bone tissue. During childhood and adolescence, much more bone is deposited than withdrawn as the skeleton grows in both size and density.

The amount of bone tissue in the skeleton (known as bone mass) can continue to increase until your child reaches his/her mid-20s. At that point, bones have reached their maximum strength and density, or peak bone mass. Up to 90% if peak bone mass is acquired by age 18 in girls and ate 20 in boys, which makes youth the best time for your kids to "invest" in their bone heath.

How can I help keep my kids' bones healthy?

The same healthy habits that keep your kids going--and growing--will also benefit their bones. One of the best ways to encourage healthy habits in your children is to be a good role model yourself. Believe it or not, your kids are watching, and your habits--both good and bad--have a strong influence on theirs.

What are the two most important lifelong bone health habits to encourage now?

Proper nutrition and plenty of physical activity.

Eating for healthy bones means getting plenty of foods rich in calcium and vitamin D. Most kids get enough vitamin D from sunlight (or from foods like egg yokes or fortified milk), but most do not get enough calcium in their diets. Younger kids (ages 2-8) are more likely to get adequate calcium, but among older kids (ages 9-19), only 19% of girls and 52% of boys get enough calcium to ensure optimal peak bone mass.

How can I persuade my daughter to drink milk instead of diet soda? She thinks milk will make her fat.

Soft drinks tend to displace calcium-rich beverages in the diets of many children and adolescents. In fact, research has shown that girls who drink soft drinks consume much less calcium than those who do not.

It's important for your daughter to know that good sources of calcium don't have to be fattening. Skim milk, low-fat cheeses and yogurt, calcium-fortified juices and cereals, and green leafy vegetables can all fit easily into a healthy, low-fat diet. Replacing even one soda each day with milk or a milk-based fruit smoothie can significantly increase her calcium intake.

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But my kids don't like milk.

Drinking milk isn't the only way to enjoy its benefits. For example, try making soup and oatmeal or other hot cereals with milk instead of water. Pour milk over cold cereal for breakfast or a snack. Incorporate milk into a fruit smoothie or milkshake. Chocolate milk and cocoa made with milk are also ways to increase the milk in your child's diet.

Sources of calcium also might include an ounce or two of cheese on pizza or a cheeseburger, a cup of calcium-enriched orange juice, or a small carton of yogurt. Your kids can also get calcium from dark green, leafy vegetables like kale or bok choy, or foods such as broccoli, almonds, tortillas, or tofu made with calcium. Many popular foods--cereals, breads, juices--now have calcium added, too. Check the Nutrition Facts label on the package to be sure.

My teenage son loves milk, but it seems to upset his stomach. Could he have lactose intolerance?

People with lactose intolerance have trouble digesting lactose, the sugar found in milk and diary foods. Lactose intolerance is not common among infants and young children, but can occur in older children, adolescents, and adults. It is more common among people of African American, Hispanic, Asian and American Indian descent.

Most kids with lactose intolerance are able to digest milk in smaller amounts and combined with other foods, like cereal. They may tolerate other dairy products such as cheese or yogurt even if milk is a problem. Lactose-free milk products are now available in most stores, and there are pills and drops you can add to milk and dairy products that make them easier to digest.

Be sure to include plenty of foods with calcium in the meals and snacks you plan for your kids. Almonds, calcium-fortified orange juice, tortillas, fortified cereals, soy beverages, and broccoli with dip are a few great choices. While it's best to get calcium from food, calcium supplements can also be helpful.

My daughter is constantly dieting. Should I be concerned?

Maintaining proper weight is important to overall health, but so is good nutrition. If your daughter is avoiding all milk and dairy products and severely restricting her food intake, she is probably not getting enough calcium. She needs a more balanced diet that includes low-fat milk products and other calcium-rich foods. Calcium supplements may also be helpful to ensure that she gets enough of this essential nutrient.

You should discuss your concerns with your daughter's doctor. If you daughter is one of the almost 5% of American girls and young women with eating disorders, the problem is even more serious. Eating disorders, especially anorexia nervosa, can lead to missed or irregular menstrual periods or the complete absence of periods, known as amenorrhea. These are signs of low estrogen, a hormone that is essential for developing bone density and optimal peak bone mass. Girls with anorexia nervosa will often have fractures as a first sign of the disease. Furthermore, reduction in estrogen production in adolescence will increase your daughter's risk of osteoporosis and fracture later in life. In severe cases, girls with eating disorders may even develop osteoporosis as early as their 20s. In severe cases, the damage to their bones cannot be reversed later in life.

Look for the following signs and see your daughter's physician if you think your daughter has, or is at risk of developing, an eating disorder:

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Should I give my kids calcium supplements?

Experts believe calcium should come from food sources whenever possible. However, if you think your children are not getting adequate calcium from their diet, you may want to consider a calcium supplement. For optimal absorption, no more than 500mg of calcium should be taken at one time.

How does physical activity help my kids' bones?

Muscles get stronger when we use them. The same idea applies to bone: the more work they do, the stronger they get. Any kind of physical activity exercise is great for your kids, but the best ones for their bones are weight-bearing activities like walking, running, hiking, dancing, tennis, basketball, gymnastics, and soccer. (Children who tend to play outside will also have higher vitamin D levels.) Swimming and bicycling promote your kids' general health, but are not weight-bearing exercises and will not help build bone density. Organized sports can be fun and build confidence, but they are not the only way to build healthy bones.

The most important thing is for your kids to spend less time sitting and more time on their feet and moving. Along or with friends, at home for at the park--one of the best gifts you can give your children is a lifelong love of physical activity.

Is it possible to get too much exercise?

For most people, including children and teens, the challenge is to get enough physical activity. However, excessive exercise and over training, often coupled with restrictive eating, can be a problem, especially for some female athletes and dancers, we well as girls who become obsessive about weight loss. Over training, like eating disorders, can result in decreased estrogen and eventually lead to thin bones that break easily.

Years ago, it was not unusual for coaches and trainers to encourage athletes to be as think as possible for many sports, including dancing, gymnastics, figure skating, running and diving. Fortunately, many coaches now realize that being too thin is unhealthy and can negatively affect performance as well as lifelong health.

So, my kids need to eat foods that are rich in calcium and get plenty of weight-bearing exercise. Is there anything else they can do to keep their bones healthy?

Yes. They should avoid smoking. You probably know that smoking is bad for the heart and lungs, but you may not know that it's harmful to bone tissue. Tobacco, nicotine, and other chemicals found in cigarettes may be directly toxic to bone, or they may inhibit absorption of calcium and other nutrients needed for bone heath. The many dangers associated with smoking make it a habit to be avoided.

You may think it's too early to worry about smoking, but the habit typically starts during childhood. In fact, most people who use tobacco products start before they finish high school. The good new? If your kids finish high school as non-smokers, they will probably stay that way for life.

My 8-year-old son is a daredevil and has already broken several bones. Could he have a problem like osteoporosis at this young age?

Osteoporosis is rare among children and adolescents. When it occurs, it is usually caused by an underlying medical disorder or by medications used to treat such disorders. This is called secondary osteoporosis. It may also be the result of a genetic disorder such as osteogenesis imperfecta, in which bones break easily from little or no apparent cause. Sometimes there is no identifiable cause of juvenile osteoporosis. This is known as idiopathic juvenile osteoporosis. Two ore more low-impact fractures may be a sign of one of these disorders.

If you are concerned about your son's frequent fractures, talk to his doctor for more information.

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How can I get through to my kids? They sure don't think about their bones?

You are absolutely right. Research has shown that children and adolescents do not tend to think much about their health. Their decisions about diet and exercise, for example, are rarely made based on "what's good for them." But we also know that you have a much greater influence on your kids' decisions and behaviors than you may believe. For example, many teenagers, when asked who has been the greatest influence in their life, name parents before friends, siblings, grandparents, and romantic partners.

The best way to help your kids develop healthy habits for life is to be a good role model yourself. Research suggests that active children have active parents. If you make physical activity a priority and try hard to maintain a healthy diet, including plenty of calcium, chances are your positive lifestyle will "rub off" on them along the way. Following are some things you can do:

All information is taken from the NIH Osteoporosis and Related Bone Disease--National Resource Center
http://www.osteo.org

Graphic showing milk, eggs, and cheese.

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