When new parents think about their child’s future, they often focus on saving for college tuition. That’s important, but something just as essential often gets shrugged off as an issue for older adults: Building your child’s bone bank.
Nutrition and physical activity during the early years can determine if someone ends up with bone ailments like osteoporosis and frequent bone breaks decades later. It should be a top concern for parents when they think about their child’s development, says Laura Bachrach, MD, a pediatric endocrinologist at Stanford Medicine Children’s Health and professor emeritus at Stanford School of Medicine.
The problem, she says, is the issue doesn’t receive enough attention among pediatricians, parents and schools. These days, many children don’t get enough vitamin D and calcium in their diet or participate in enough physical activity important for bone health.
She spoke with Bay Area Parent about how parents can help their child’s skeletal health and how this subject can become a more prominent concern in society.
People often think bone complications happen as you grow older. Why should parents care about their child’s bone health?
You reach your peak bone strength by your early 20s. So, you can’t wake up when you’re 45 and say, “Oh no, here comes menopause and I need to do something.” You are building your bone bank until you are in your early 20s; that is as strong as it’s going to be for your lifetime, and then you want to maintain it. That’s why parents should care.
What are key things parents can do to help build the bank?
There are things you can modify in childhood. You can’t change genetics, but you can change the modifiable things. There’s physical activity, and it has to be weight-bearing, so swimming doesn’t count. Adequate nutrition, which means don’t be overweight and don’t be underweight and get all of the key nutrients. You want to avoid, if you can, the problem of losing your menstrual cycle because you’re too skinny, which goes with nutrition. You want to avoid medications that aren’t good for you.
Where are kids falling short in improving bone strength?
What concerns me is that a lot of kids who don’t eat dairy at all. They think it’s bad for them. They don’t realize the American Academy of Pediatrics says every child should be on vitamin D. We’re getting better about wearing sunscreen, but even an SPF 8 is enough to block about 95% of vitamin D. People often say I get out in the sun so I don’t need to take vitamin D. But if you’re using sunblock like you should, you won’t be getting vitamin D. Kids are substituting coffees from Starbucks and juices for dairy. …Physical activity is important and getting the calcium and, if you’re not doing dairy, you can drink soy milk, fortified orange juice, take a multivitamin or vitamin D.
Is this something girls need to worry about more than boys because women are more prone to osteoporosis?
Men do have larger bones and that’s why they don’t get osteoporosis. It’s a biomedical advantage. Women at menopause have a sharp decline in bone health. For men, it’s more gradual.
But males have to be worried about this, too, such as kids who are in sports where there is a focus on being skinny, which you see in ballet. But you also see it in boys who are in flyweight wrestling, runners and cyclists. The kids who are exercising more than they are taking in, it is really bad for them. It causes a hormone deficit. That’s as bad as being vitamin D deficient because you are exercising without adequate fuel. Boys do have more fractures in childhood than girls. Boys have to think about this.
Are there medications children take that can negatively impact calcium and vitamin D levels?
Regarding calcium, glucocorticoids, like prednisone, can reduce absorption and increase loss of calcium. This adds insult to injury as steroids have a direct adverse effect on bone health. Proton pump inhibitors, taken to reduce stomach acid, also reduce absorption of calcium. Calcium is best absorbed with meals because of the stomach acid that is secreted when you eat.
Vitamin D absorption and/or metabolism can be affected by glucocorticoids or anticonvulsants. For patients on anti-seizure medications or steroids, physicians should encourage a daily supplement of vitamin D and should monitor vitamin D levels in the blood at least yearly.
Who should be stressing the importance of children’s bone development to parents?
I think pediatricians need to get that message out to parents more. When I’ve talked to pediatrician groups about this, all they wanted to talk about is just vitamin D. That’s part of it, but you have to pay attention to all of the variables. The pediatrician has a role to play, but it’s really our whole society. …The message has to be a global message of thinking about all of the factors. It’s not enough to just pop your vitamin D every day. You have to do some weight-bearing physical activity. Schools could help too if they have recess that involves jump roping and serving calcium-containing foods at lunchtime.
Kid-Friendly Snacks & Meals Rich in Calcium and Vitamin D
Calcium
- Salmon sandwich made with canned salmon with bones.
- Pizza bagel with mozzarella cheese.
- Cheese cubes and apple skewers.
- Almond butter on apple slices.
- Peanut butter banana smoothie.
- Mashed potatoes with evaporated milk.
Vitamin D
- Make a watermelon and strawberry smoothie with yogurt.
- Combine layers of yogurt, nuts, cereal and berries to make a yogurt parfait.
- For children who can’t eat dairy products, blend silken tofu with berries, honey and orange or lemon zest to make a tasty dessert.
- Use chopped and sliced vegetables with hard-boiled eggs to make funny egg animals.
- Serve French toast with cheese.
Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases
Exercise to Build Strong Bones
Children ages 3 to 5 should be physically active throughout the day. Adults should encourage a variety of activities during play. Youth ages 6 to 17 should spend at least one hour every day exercising, most of it moderate or vigorous intensity. They should use some of this time for muscle strengthening exercises at least three days a week. They should do bone-strengthening exercises at least three days a week.
- Brisk walking (three to four miles per hour)
- Climbing stairs
- Hopping, skipping and jumping (including jumping rope)
- Judo
- Running or jogging
- Dancing
- Gymnastics
- Team sports like soccer or basketball
- Tennis, badminton, ping pong, pickleball and other racket sports
How to be a role model:
- Join your children for a walk or run in the park, or play sports together.
- Assign active chores to your children, such as walking the dog or raking leaves.
- Plan a few short exercise blocks (10 to 15 minutes) at different times of the day.
- Clear space in a room for physical activity.
Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases
Resources
National Institute of Arthritis and Musculoskeletal and Skin Diseases. Supports research into the causes, treatment and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. niams.nih.gov/health-topics/kids-and-their-bones
Pediatric Endocrine Society. Provides pediatric endocrinology resources, education, and news and publications. pedsendo.org/patient-resource/bone-health
Nemours Kids Health. Website offers tools for families to make health choices. kidshealth.org/en/parents/strong-bones.html
