Bones are 70 percent calcium, and it is minerals such as calcium which give bones their hardness for protection and support. What most people may not know is that bones also serve as the calcium bank of the body. There are daily deposits and withdrawals of calcium from bones. Calcium is vitally important in other organs in the body – mainly muscles. Without enough calcium, a person’s heart may beat out of rhythm or even stop! The release of calcium from bones prevents dangerously low calcium levels in the body.

Most people recognize strong relationship between calcium and vitamin D. The job of vitamin D is bringing calcium from foods eaten into the body for use. It also helps bone store calcium.

There are two prime time periods in a child’s life requiring enough calcium and vitamin D. Rapid growth happens in both of these periods which are infancy/early childhood and adolescences.

Rickets is the consequence of not enough calcium delivered into the body during infancy/early childhood. Bones are soft without enough calcium and can bow/deform or even break. Low calcium levels lead to muscle weakness and irritability.

The signs/symptoms of not enough calcium or vitamin are much harder to see in adolescence. Osteoporosis and easily breaking bones is possible in severe cases. However, most teens will have no symptoms. However, the worry is that teens without enough calcium in their bones risk osteoporosis or other bone problems occurring earlier in adulthood.

Bone health is even more important in medically complicated children such as those followed at Cook Children’s Bone Health clinic. Children such as those with childhood cancer, digestive disorders, rheumatoid arthritis, cerebral palsy, or osteogenesis imperfecta (brittle bone disease) are at high risk for bone breaks and daily bone pain. They often require other treatments in addition to supplemental calcium and vitamin.

The beginning of good bone health for otherwise healthy children begins with a good diet with enough calcium and vitamin D. It is sometimes hard, however, to know how much calcium or vitamin D is needed or if a child should take a supplement.

Recommended Intake

Dietary Reference Intakes – Recommended Dietary Allowances (meet needs of 98% of the population) IU= International Unit

Eat and drink low-fat or fat-free dairy (best source of calcium)

2-8 years: 2-3 servings per day 9-18 years: 3-4 servings per day

Sources of Calcium and Vitamin D in the diet

Calcium or Vitamin D supplementation?

Calcium supplements may be the best way for you to get enough calcium if you cannot meet the recommendations. Dairy sources of calcium are better absorbed than non-dairy sources so individuals with milk protein allergy or lactose intolerance may have trouble meeting their needs. When using supplements be careful of high intakes of calcium as it can lower absorption of other minerals like iron.

Due to low availability of Vitamin D from foods, supplementation may need to be considered even when a deficiency is not present.

For more information on finding the right supplement visit www.FDA.gov or www.usp.org.

I’d be hard pressed to compare waiting for a doctor’s appointment including an appointment with me to the anticipation of waiting in line for any Disney ride or show.

It happens that the question about Disney and healthcare actually crossed my mind in March. While checking in on Twitter, I came across an intriguing book mentioned by one of the folks whom I follow: @JohnNosta.

The skeptic in me wondered how the entertainment industry could have any relevance to health care. Fortunately, the curious skeptic in me decided to buy the book and learn more.

The author approaches healthcare from a business, non-physician perspective focused on serving patients and those who care for patients. I found some fresh perspectives that I think will help me going forward.

Here are three pearls that I got out of the book.

Pearl 1: A focus on loyalty and not satisfaction

Loyalty and trust are different from satisfaction. Loyalty is built on a consistent caring and engaged compassion. Loyalty is built in large part by creating a memorable event in a patient care experience.

Pearl 2: Courtesy is more important than efficiency

A commitment to courtesy both improves experience and can lead to opportunities for efficiency improvement.

A focus on the satisfaction and service for others in your institutional may improve responsiveness and lead to better sharing of resources.

Pearl 3: Create a climate of dissatisfaction

Dissatisfaction with the status quo combined with the dream for what can be are key ingredients in growth and improvement. Even when all measures are near the top, there will always be room for improvement.Final Thoughts

I don’t believe it’s completely valid to compare the work done by me and others at Cook Children’s to work done in other service fields. Stakes and expectations are much higher - solving a problem, managing chronic illness, fixing a hurt - than getting a Starbucks order right or the thrill of a roller coaster ride.

Still we are all compared to real life experiences. Waiting in line is seldom fun. And the ride is sometimes not a ride the child or family would choose. We can still strive to make the experience as pleasant as possible.

About the author

Joel Steelman, M.D., is an endocrinologist at the Cook Children's Endocrine and Diabetes program, which treats infants, children and teens with conditions that are caused by or affect the hormonal balance of the body. We understand the importance of working together and that's how we approach the care of our children.