Dr. Ankur Saurav

MBBS (Gold Medalist)
DNB Orthopedics
Diploma in Orthopedics
Fellowship in Arthroplasty (Joint Replacement), Revision Arthroplasty and Arthroscopy (Munich, Germany)
Fellowship in Sports Medicine (ISAKOS: International Society of Arthoscopy, Knee Surgery And Orthopedic Sports Medicine)

Children And their Bones

CHILDRENS AND THEIR BONES: A Guide for Parents

Introduction :

Typically, when parents think about their children's health, they don't think about their Bone Health. But building healthy bones by adopting healthy nutritional and lifestyle habits in childhood is important to prevent osteoporosis (weak bones), fractures, joints and spine problems later in life.

What is Osteoporosis and its significance in childrens :

Osteoporosis, the disease that causes bones to become less dense and more prone to fractures, has also been called " A childhood disease with old age consequences ". Because the bone mass attained in childhood and adolescence is an important determinant of life long bone health.
The healthy habits of your kids forming now "can make, or literally break " their bones as they age.

Why is childhood such an important time for bone development ?

Bones are the framework for your child's growing body. Bone is living tissue that changes constantly with bits of old bone being removed and replaced by new bone.
You can think of the bones 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 During childhood and adolescence much more bone is deposited than withdrawn. The amount of bone tissue in the skeleton (known as bone mass) peaks by their late twenties. At that point bone have reached their maximum strength and density. Upto 90% of the Peak bone mass is acquired by age 18 years in female and 20 years in boys, which makes youth the best time for kids to "invest" in their bone health. Building Your Children "Bone Bank" Account is lot like Saving for their Education : The more they can put when they are young, the longer it should last as they get older.

Factors Affecting "PEAK BONE MASS"

Peak bone mass is influenced by number of factors: some are non modifiable( that you can't change) and some are modifiable (that you can change).

    Non modifiable factors
  • 1.GENDER/SEX : Bone mass or density is generally higher in men than in women.
  • 2.Race : Their are differences in various racial and ethnic groups regarding bone mass.
  • 3.Hormonal factors : Sex hormones are essential for the development of the bone mass. Girls who attain their mensturation at an early age typically have greater bone density. Those who frequently miss their periods sometimes have lower bone density.
    Modifiable factors
  • 1.Nutritional Status:
    Calcium is an essential nutrient for bone health. A well balanced bone diet includes adequate amounts of Vitamins and Minerals such as Magnesium, Zinc and Vitamin D is also important
  • 2.Physical Activity:
    Physical activity is important for building healthy bones.
    The stress and strain we put our bones into during activity is directly proportional to bone quality and bone strength building.
So no to gadgets (Mobile, television etc) and send your children to playground/park to play. I literally mean it, make your child run and play outdoor sports. With modernism coming in, working parents having less time to spare for their children and few place for our children to play outside is serious issue to delt with.


List of Questions you may have in your mind:


Q1. What are Calcium and Vitamin D rich food sources ?

Refer to chart below:

Sunlight is very important source of Vitamin D


Q2. 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.
The two most important lifelong bone health habits to encourage now are Proper nutrition and Plenty of Physical activity.
Eating for healthy bones means getting plenty of foods that are rich in Calciumand Vitamin D. Most kids do not get enough calcium in their diets to help ensure optimal peak bone mass.
Are your kids getting enough calcium?
Calcium is found in many foods, but the most common source is milk and other dairy products. Drinking 250ml glass of milk provides 300 milligrams(mg) of calcium, which is about one-third. of the recommended intake for younger children and about one-fourth. of the recommended intake for teens. In addition, milk supplies other minerals and vitamins needed by the body. The chart on the next page lists the calcium content for several high-calcium foods and beverages. Your kids need several servings of these foods each day to meet their need for calcium

Refer chart :
Recommended amount of calcium per day


Q3.How can I persuade my daughter to drink milk instead of cold drinks ? 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.

Q4. But my kids don't like milk, what to do? ?

Drinking milk isn’t the only way to enjoy its benefits. For example, try making soup and oat meal 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.
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 such as cereals, breads, and juices now have calcium added too. Check the Nutrition Facts label on the package to be sure.

Q5. 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 dairy 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.
Many kids with lactose intolerance are able to digest milk when it is served in small 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, spinach and broccoli with dip are a few great choices. Although it’s best to get calcium from food, calcium supplements can also be helpful.

Q6. 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 your daughter is one of up to 3 percent of Indian 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 reaching 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 can increase your daughter's risk of osteoporosis and fracture later in life. In severe cases, girls with eating disorders may even develop osteoporosis in their twenties, and they may find 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:

  • Missed menstrual periods after having had them regularly for at least several months.
  • Extreme and/or unhealthy-looking thinness.
  • Extreme or rapid weight loss.
  • Frequent dieting practices such as:
  • Eating very little.
  • Not eating in front of others.
  • Trips to the bathroom following meals.
  • Preoccupation with thinness.
  • Focus on low-calorie and diet foods.
  • Overtraining or excessive exercise.

Q7. 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 consider a calcium supplement.

Q8. How does physical activity help my kids' bones?

Muscles get stronger when we use them. The same idea applies to bones: the more work they do, the stronger they get. Any kind of physical 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. Resistance exercises like – lifting weights – can also strengthen bones. Swimming and bicycling promote your kids' general health, but do 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. Alone or with friends, at home or at the park, one of the best gifts you can give your kids is a lifelong love of physical activity.

  • Walking
  • Tennis
  • Running
  • Volleyball
  • Hiking
  • Ice hockey/ field hockey.
  • Dancing.
  • Skiing.
  • Soccer
  • Skateboarding.
  • Gymnastics.
  • In-line skating.
  • Basketball.
  • Lifting weights.
  • Jumping rope.
  • Aerobics.

Q9. 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 overtraining, often coupled with restrictive eating, can be a problem, especially for some female athletes and dancers, as well as girls who become obsessive about weight loss. Overtraining, 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 thin 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.

Q10. What else can my kids do besides eating calcium-rich foods and getting plenty of weight-bearing exercise to keep their bones healthy?

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. Smoking may harm your bones both directly and indirectly. Several studies have linked smoking to higher risk of fracture. 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 or adolescence. In fact, most people who use tobacco products start before they finish high school. The good news? If your kids finish high school as nonsmokers, they will probably stay that way for life.
Children who learn good eating and exercise habits by their preteen years are more likely to carry these habits with them for the rest of their lives.

Q11. My son has asthma and takes a steroid medication to control it. His doctor said this might affect his bones. Is there anything we can do about this?

Asthma itself does not pose a threat to bone health, but some medications used to treat the disease can have a negative effect on bones when taken for a long time. Corticosteroids, a type of anti-inflammatory medication, are often prescribed for asthma. These medications can decrease calcium absorbed from food, increase calcium loss from the kidneys, and shrink a child's bone bank account.
Kids with asthma need to take special care of their bones, making sure to get enough calcium along with weight-bearing and resistance exercise. Some health care providers recommend extra calcium each day. Many people think milk and dairy products – great sources of calcium and vitamin D – trigger asthma attacks, but this is probably true only if your child is allergic to dairy foods. Unfortunately, this misconception often results in an unnecessary avoidance of dairy products, which is concerning, especially during the bone-building years. Because exercise can often trigger an asthma attack, many people with asthma avoid weight-bearing physical activities that strengthen bone. Kids with asthma may be able to exercise more comfortably in an air-conditioned place, such as a school gym or health club.
Talk to your child's doctor for more information about protecting his bones while he is taking asthma medications.

Q12. 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.

  • Some disorders, medications, and behaviors that may affect peak bone mass
  • Primary disorder
  • Juvenile arthritis
  • Diabetes mellitus
  • Osteogenesis imperfecta
  • Hyperthyroidism
  • Hyperparathyroidism
  • Cushing's syndrome
  • Malabsorption syndromes
  • Anorexia nervosa
  • Kidney disease
  • Liver disease
  • Medications
Some anticonvulsants (e.g., for epilepsy)
Corticosteroids (e.g., for rheumatoid arthritis, asthma)
Immunosuppressive agents (e.g., for cancer)
  • Behaviors
  • Prolonged inactivity or immobility
  • Inadequate nutrition (especially calcium, vitamin D)
  • Excessive exercise leading to amenorrhea
  • Smoking
  • Alcohol abuse

The best way to help your kids develop healthy habits for life is to be a good role model. 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. Here are some things you can do:

Be a role model. Drink milk with meals, eat calcium-rich snacks, and get plenty of weight-bearing and resistance exercise.

Don't smoke

Incorporate calcium-rich foods(Refer charts)into family meals.

Serve fat-free or low-fat milk with meals and snacks.

Stock up on calcium-rich snacks that are easy for hungry children to find, such as:

  • Cheese cubes and string cheese.
  • Single-serving puddings.
  • Yogurt and frozen yogurt
  • Cereal with low-fat milk.
  • Cheese cubes and string cheese.
  • Broccoli with yogurt dip.
  • Calcium-fortified orange juice.
  • Almonds.
  • Limit access to soft drinks and other snacks that don't provide calcium by not keeping them in the house.
  • Help your kids to find a variety of physical activities or sports they enjoy participating in.
  • Establish a firm time limit for sedentary activities such as TV, computers, and video games.Yogurt and frozen yogurt
  • Teach your kids to never start smoking, as it is highly addictive and toxic.
  • Look for signs of eating disorders and overtraining, especially in preteen and teenage girls, and address these problems right away.
  • Talk to your children's pediatrician about their bone health. If your child has a special medical condition that may interfere with bone mass development, ask the doctor for ways to minimize the problem and protect your child's bone health.
  • Talk to your children about their bone health, and let them know it is a priority for you. Your kids may not think much about health, but they are probably attracted to such health benefits as energy, confidence, good looks, and strength.

Q13. What is osteoporosis? Isn't it something old people get?

Osteoporosis is a disease that causes bones to become fragile and break easily. When someone has osteoporosis, it means his/her “bank account” of bone tissue has dropped to a low level. If there is significant bone loss, even sneezing or bending over to tie a shoe can cause a bone in the spine to break. Hips, ribs, and wrist bones also break easily. The fractures from osteoporosis can be painful and disfiguring. There is no cure for the disease. Osteoporosis is most common in older people but can also occur in young and middle-aged adults. Optimizing peak bone mass and developing lifelong healthy bone behaviors during youth are important ways to help prevent or minimize osteoporosis risk as an adult.

Q14. What is the recommendation of daily intake of Calcium?

Refer to the chart below. Note: The above information shared by the author is for information and awareness of the parents and thier kids. No one should start practicing and prescribing medicine or other advice regarding bone health. If any concerns arises one should meet his doctor for further consultation.