Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

Calcium is very important for growing children as it helps them build and maintain healthy bones.  This week, Registered Dietitian Karen Kafer talks about calcium requirements for children and different sources of calcium.

Karen Kafer, RD B.S. Oklahoma State University VP Health Partnerships at National Dairy Council Past experience: VP, Communications for Kellogg Company Website: The Dairy Report Contact via email – karen.kafer@rosedmi.com

Question: There are several calcium choices I could provide for my child—which one(s) should I choose?

Answer:

Since children are often picky about what they eat, parents are challenged to find foods kids like that also provide the nutrients they need.  The Food and Nutrition Board of the National Academy of Sciences recommends children consume adequate calcium in their diets.  This means:

• 500 mg of calcium a day for kids who are 1 to 3 years old;
• 800 mg of calcium a day for kids who are 4 to 8 years old; and
• 1,300 mg of calcium a day for kids who are 9 to 18 years old 2 .

To reach these recommended calcium levels, there are several options parents can provide for their children.  Calcium can be found in dairy foods such as milk, cheese and yogurt, vegetables like broccoli, kale and spinach, as well as salmon, red beans and fortified juices and cereals.  However, different calcium sources provide various levels of calcium and also vary in how easily they are absorbed in the body.

To compare, a one cup serving of milk or yogurt or 1.5 ounces of natural cheddar cheese contains about 300 mg of calcium on average.  However, to obtain the same amount of calcium in one cup of milk, a child would have to eat 10 cups of raw spinach, nearly 4 ¾ cups of canned red kidney beans or 4 ¾ cups of cooked broccoli.  As for foods fortified with calcium, they vary in both their calcium content and quality, so be sure to read food labels to determine how much calcium these products contain.  Check the ingredient section of the food label to determine the type of calcium (such as calcium carbonate, calcium citrate, calcium malate, etc.) used during fortification.

Another option for children is calcium supplements or supplements containing calcium; however, it’s recommended that parents always consult a pediatrician before giving children supplements of any kind.  According to the National Institute of Health, “the two main forms of calcium in supplements are carbonate and citrate. Calcium carbonate is more commonly available and is both inexpensive and convenient. Both the carbonate and citrate forms are similarly well absorbed, but individuals with reduced levels of stomach acid can absorb calcium citrate more easily. Calcium citrate malate is a well-absorbed form of calcium found in some fortified juices. The body absorbs calcium carbonate most efficiently when the supplement is consumed with food, whereas the body can absorb calcium citrate equally effectively when the supplement is taken with or without food.”  Unless a child has a dairy allergy and must avoid dairy, it’s important to remember foods naturally containing calcium, such as milk and milk products, rather than supplements, are the preferred source of calcium for both you and your child.

Vitamin D helps promote the absorption of calcium and enhances bone mineralization.  In fact, a glass of milk fortified with vitamin D provides about 25 percent of the Daily Value for vitamin D, and aids in this calcium absorption and bone mineralization enhancement.  Milk is one of the few dietary sources of this important nutrient so it’s important for children to have their recommended amount of low-fat and fat-free milk and milk products every day.

Resources:

Milk’s unique nutrient package from National Dairy Council

Calcium content of select foods – USDA national nutrient database for standard reference

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Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

This is part 2 of a series by guest writer Lauren Morgan, a dietetic intern at the University of Maryland and blogger at The Blue Plate Special. Having grown up with food allergies, and because of her training as a dietitian, she has a strong interest and technical knowledge of this topic. Feel free to leave a question or comment for follow up!

In part 1 on milk allergy, we introduced a definition and some common symptoms of milk allergy. In this second part, we offer a few tips if you are trying to manage your child’s nutrition when he or she has a known milk allergy.

Do we know the reasons why a child may develop milk allergy? Is it because of genetic reasons or are there environmental factors?

This is a good and complicated question because the causes of allergies are not well understood.  Children develop allergies when they come into contact with allergens, thus this is an environmental trigger.  Children are at greater risk for developing allergies if one or both parents have allergies, so this is the genetic component.  Researchers do think that there is generally a strong genetic component although it is not well understood.

How to achieve proper nutrition and avoid calcium and vitamin D deficiency if my child has a milk allergy?

Like we mentioned last week, milk is a great source of calcium and vitamin D which are very important to the body.  Calcium is key for healthy bones, especially for children as their bodies are growing and developing, and vitamin D is necessary for our bodies to absorb the calcium.  The good news for parents of kids with milk allergies is that there are other places to get these important nutrients if your child cannot have any milk or milk products.

Many foods are fortified with calcium these days including fortified ready-to-eat cereals, soy milk (although many children with milk allergy are also allergic to soy so be careful with this one), sardines, collards, spinach, kale, okra, and soybeans and tofu (again watch out for the soy allergy).  Many of these foods have much lower amounts of calcium then a dairy source so be aware of this to make sure your child is getting enough calcium.

Our bodies can make vitamin D, and all we need for this is some sunlight to activate the process!  However, many Americans are deficient in vitamin D for several reasons including that we are more careful and precautious in the sun by applying more sunscreen.  While sunscreen is very important (especially on your children!) it is still possible to make some vitamin D.  By exposing your arms and legs in the sun for about 15 minutes and then applying sunscreen you will be safe in the sun and produce enough vitamin D when doing this 2-3 times a week.  If you are uncomfortable with this or do not think you can be out in the sun enough then food sources or a multivitamin with vitamin D are a good way to make sure you are getting enough.  Food sources include egg yolks, saltwater fish, liver, and some vitamin-D fortified cereals.

What precautions should be taken when traveling or eating out?

Eating out when you have a child with a milk allergy can be a scary thing.  Closely evaluate the menu and pick items that are traditionally milk free; however, you cannot completely rely on this because you never know what ingredients a specific recipe will call for.  The safest strategy is to ASK!  Talk to your server and ask to speak with the chef; they can tell you exactly what ingredients are in the dish and if it is safe for your child to eat.

The Food Allergy and Anaphylaxis Network has a wonderful resource for eating out!  Their chef card template is available for download for FREE.  Just fill out the card with the ingredients your child cannot have and then present this to your chef when dining out.

Stay alert, stay safe, and stay nutritious with food allergies!
©2010 Littlestomaks.com

According to the 2nd edition of the PDR for Nutritional Supplements -

The absorption efficiency of calcium varies throughout the life span. It is highest during infancy when it is about 60%. In prepubertal children, it is about 28%. During early puberty, at the time of the growth spurt, it increases to 34% and then drops to 25% two years later.

How you can use this information -

1. Get your kids to drink milk and eat yogurt at an early age. Dairy is the best source of calcium. Unless you have an allergy problem, this should be your first choice. Milk also has vitamin D which is necessary for calcium absorption.
2. Other sources of calcium and vitamin D – fortified orange juice, cereals, collard greens, broccoli, tofu, salmon, spinach. Offering a variety of food sources in addition to, or instead of dairy, is a good way to get calcium in your child’s growing bones early on.
3. Recommended daily value for children 1-3 years is 500 mg (about 2 cups of milk) and for children 4-8 years is 800 mg (2-3 cups of milk).
4. In addition to food sources, physical activity is also important. Both exercise and nutrition help bones to increase their strength.

Building a calcium reserve at an early age is almost like building a bank balance of good health for the rest of your child’s life.

What has worked well for you in providing adequate amount of calcium and vitamin D in your child’s diet?

©2009 Littlestomaks.com
Information provided in this post is not meant to be treated as medical advice

In her recent article Vaccine for ear infections soon to be on the market,  Chicago Family Health Examiner Jasmine Jafferali, MPH, wrote that the underlying cause of chronic ear infections in children could be milk allergy. I was so intrigued by this suggestion that I contacted her to address this idea in a Question-Answer format for my blog. If your child is suffering from chronic ear infections and you are concerned about excessive use of antibiotics, this article is a must read for you! Let me know what you think!

Question: You have said that milk allergy is an underlying cause for chronic ear infections. Can you provide a credible reference to support this?

Jasmine: Dr. Greene, a prominent pediatrician,  has discussed a link to milk allergies and ear infections.  Up to 40 percent of kids who suffer from chronic ear infections has a milk allergy.  In fact a 1997 report on food allergies in the Journal of the American Medical Association found that cow’s milk allergies tend to hit children in their infancies, showing up as colic, acid reflux or eczema.  However many pediatricians are overlooking the possibility of food allergies, especially milk allergies to chronic ear infections.

Question: How can parents recognize the signs of food allergy and dairy allergy in particular?

Jasmine: Although a child can develop an allergy to almost any food, well over 90 percent of food allergies in children are caused by one of only six foods: milk, eggs, peanuts, wheat, soy, and tree nuts. The immediate symptoms of food allergies in babies and toddlers are irritability, colic, wheezing (sometimes asthma), a minor rash, chronic runny nose, or itchy eyes. These more immediate symptoms are less likely to occur than slower onset symptoms, which your baby can experience seven to 10 days after exposure to cow’s milk.  These more common symptoms include diarrhea (possibly with blood), abdominal cramps, vomiting, coughing, gagging, acid reflux, ear infections, runny nose, eczema and colic.

Food allergies is becoming more and more common in our children.  Parents are fearful and the information out there is confusing.  These findings are all consistent with the 2008 American Academy of Pediatrics guidelines that overturned previous recommendations by declaring that there is no evidence that delaying any food beyond 4 to 6 months helps prevent allergies at all — for healthy term children who are not already allergic.  However, many parents get quite excited introducing solids to their infants.  Remember, the main source of nutrition for an infant is breastmilk or formula for the first year of life and solid food is meant to be the supplement.  Look for signs that your baby is ready to eat solids.

Question: What kind of questions should parents ask when an antibiotic is prescribed?

Jasmine: If an antibiotic is prescribed some questions to ask are:

1. Is the infection bacterial or viral?  If viral, then antibiotics will not improve symptoms of the ear infection.  It is like being prescribed antibiotics for a cold.  Ask for possible alternatives.
2. Where is the location of the infection?  If the infection is in the middle ear, ask if waiting it out is an option and what you can do to help minimize their pain.  Eighty percent of ear infections will resolve on its own within 4 to 7 days without antibiotics.  WebMD wrote an article on this study back in 2005.
3. If my child must take antibiotics, can I give them some probiotics after the finished antibiotics to help replenish their good bacteria?  (remember antibiotics kills BOTH good and bacteria and you have replace the good back into the body)  Studies are showing the benefits of taking probiotics after antibiotic treatment and during cold and flu season.

Question: How can parents tell if they are exposing their child to excessive antibiotic use?

Jasmine: If you are in the doctor’s office for the third time in one year getting another round of antibiotics it is time to ask the long term effects of getting the antibiotics and start looking into the underlying cause for the chronic condition.  If your child is an infant, you may want to switch formulas where the formula is more broken down and easier for your baby to digest.  Or if you are breastfeeding looking at your own diet as possible issues.

Question: Can ear infections be treated without the use of antibiotics?

Jasmine: Often, an antibiotics is prescribed to treat the ear infection. According to the June 2009 British Medical Journal article, prescribing antibiotics leads to more ear infections.  In fact, if the children had taken antibiotics, there was a 63 percent chance they’d had at least one subsequent infection. The risk was only 43 percent for children who’d been given an inactive placebo.  Other studies show that it takes children only three days longer to recover from the middle ear infection without antibiotic treatment.  (see the WebMD article)

There are alternate treatments to chronic ear infections.  In fact, my own grandmother used some of these home remedies on us when we suffered from ear infections.

1. Warm compresses with a warm washcloth. Do not put the water in the ear and make sure the washcloth is not too hot.
2. Hyland’s ear drops is used with a confirmed diagnosed ear infection.  This can be purchased at your local drugstore or health food store.
3. Warm olive oil, or warm garlic infused olive oil: In test tube studies garlic has been found to have antibacterial, antiviral, and antifungal activity-garlic is a natural antiseptic!  Chop 2 garlic cloves and allow the small pieces to marinate in a half cup of olive oil for a day (if you can’t wait proceed to warming the oil over the stove).  Warm the oil slowly over the stove, it should be warm to your touch.  Get an ear dropper and put a few drops into the ear.  You may add a few more drops later in the day, the first round should do the trick.  This mix will last for about two weeks.  Many parents are turned off by this home remedy, however, there are plenty that use and swear by this method.
4. Echinacea – this is an herb which can safely and effectively boost the immune system.  Click on Dr. Greene’s guide to using Echinacea properly.
5. Chiropractic care – chiropractic adjustments to the skull and neck can improve middle ear drainage and decrease ear infections.  Many parents are finding relief going this route

Using a combo of the above will be helpful such as warm compresses and whichever remedy you choose.
WARNING – if you see any liquid or pus draining out of the ear, DO NOT PUT ANY OF THE ABOVE DROPS INTO THE EAR.

Question: Can you give suggestions to dairy alternatives if dairy allergy is found to be the cause of ear infections?

Jasmine: If you child has a confirmed milk allergy with an ELISA allergy testing, then eliminating all dairy can be a difficult transition for your child.  Finding the right dairy substitute is tricky.  Often kids allergic to dairy are often or have a hard time digesting soy.  As rice cereal was probably your child’s first food, rice milk is a nice alternative and easy to digest.  If there are no tree nut allergies, almond milk is another great substitute.  If you are concerned about your child getting the fat from the milk, you may add up to 1tsp of flax oil to the milk substitute.   There is now coconut milk yogurt and coconut milk ice cream which is both delicious and provides some great health benefits.  So Delicious is a wonderful brand and your child will not miss out.

©2009 Littlestomaks.com