Calcium and dairy free children
A lot of patients ask me about how to ensure good levels of calcium intake when dairy is being excluded from the diet in children. Calcium is really important in the body. It is required to build strong bones and teeth, helps with regulating muscle contractions, including the heartbeat, and is also involved in blood clotting.
A lack of calcium in the diet can lead to rickets in children and osteomalacia and osteoporosis in adults. Adults need about 700mg of calcium and day and children a bit less and adolescents a bit more. The amount you require can also go up with pregnancy, breast-feeding, menopause and some medical conditions. It’s always good to know how much you need personally.
I often see children in my surgery that may have cut dairy out due to allergy or personal preference. Parents have asked me how they can ensure their child is still getting enough calcium in the diet. The interesting thing is that calcium absorption is very related to the other levels of vitamins and minerals in the diet.
Good levels of vitamin D are needed to bring calcium into the body. Too much of calcium is not great either, and we see this sometimes in children who drink endless amounts of dairy milk and not enough balanced food. Calcium competes with iron and other minerals for absorption. Iron deficiency can be a common problem in children who drink too much milk. So the whole diet, and the balance of everything is super important.
So what if you have a child who is dairy free and you want to get your balance right? If the child is aged between 4-6 years of age, they will need about 450mg of calcium a day. An average child aged 7-10 years needs 500mg a day. What often happens is that children will have non-dairy ‘mylk’ alternatives instead. These can be great and there are so many alternatives now available in the supermarkets and they are easy to find. You can find oat milk, rice milk, hemp milk, and soya milk for example. We would normally advise avoiding soya milk if the child had positive blood allergy test for dairy. There is a common cross reactivity of true dairy allergy and soya. Also, if the child has been tested and shown to have soya protein allergy, we would obviously be excluding this from the diet. If soya allergy is not suspected then it is fine to use. Most of these dairy alternatives are fortified. That means they have calcium, and other nutrients added, usually 120mg of calcium per 100ml. Be a health detective. Get used to checking labels to see what the fortification is. Other food, such as wholemeal bread, can also be fortified with calcium- know your labels. Be very wary of some other ‘fortified’ foods, such as biscuits. They may also contain lots of sugar, which is not ideal.
Other foods known to be higher in calcium are small bony fish like pilchards, sardines and prawns. Sardines have about 550mg of calcium per 100g. If your child develops a taste for sardines, then that is great-they have the added bonus of good levels of omega 3 oil. Sardines can be a great addition to a healthy balanced diet. Leafy green vegetables do contain calcium. You have to have larger amounts to get your calcium levels up to daily requirements. For example, 4 tablespoons of cooked kale contains about 80g of calcium. Two spears of cooked broccoli have about 35g of calcium.
Now, one other thing to know about is oxalates. These are natural substances found in plants, which can support metabolism and not something to get too worried about, but they are good to know about. Remember, knowledge is power. Like everything in nature there is a balance. Oxalates can compete with calcium for absorption in the body. Some leafy greens, such as spinach, contain relatively higher amounts of oxalates, which cancel out the good calcium they contain. Others, like kale have a lot less. One way to sneak leafy greens into a child, from experience, is via smoothies. You can actually easily whizz up a calcium rich smoothie for breakfast for a non-dairy eating child.
Oranges also have calcium, but the bioavailability can be limited by other factors within the fruit. A medium orange can provide 75mg of calcium. Sesame seeds are also a good little source. A 56g of a sesame bar snack can provide 290mg of calcium. Again, check your labels, watch for sugar. Feeding children can be tricky, and if a child has multiple allergies and food restrictions we sometimes have to consider supplements and work closely with a person who specialises in children’s diets to make sure parents are well supported and have all the information they need.
If your child is avoiding dairy and otherwise well, with the right information and the right balance, getting the right amount of calcium into your child’s diet should not be a problem.
Thank you to my good friend Katie Samuels who is a Paediatric Dietician in London and gave me some great advice on children and calcium. This seems to be an increasingly common question I am being asked in my surgery.
British Nutrition Foundation atwww.nutrition.org.uk/attachments/article/874/Calcium/20Counts.pdf
The association of UK Dieticians at:www.bda.uk.com/foodfacts/Calcium.pdf