Your child's broken bones: 4 questions you never thought to ask
A doctor looks at why kids break their bones and when you should be concerned
Broken bones are a part of growing up for many children. It’s estimated that 1 in 3 children will have at least one broken bone before age 19 with the likelihood of a broken bone higher in boys than girls.
A parent’s natural protective instinct would be to prevent the possibility of broken bones and limit high risk activities. However, regular physical activity is important for good bone health. Strength, balance and coordination gained from regular physical activity help prevent fractures. Daily movement – walking, standing, running – all stimulate bones to take up calcium and get stronger.
1. Is my child’s broken bone bad luck or something more?
Children with weaker bones containing less calcium are at higher risk for bone pain and broken bones. There are many causes and conditions leading to overall weaker bones in children. Some of the causes are very obvious while others are challenging to detect.
Diet is an obvious first thought for many parents as a cause of weak bones. Today’s children face a minefield of diet challenges. Most parents know that a poor diet carries a high risk of obesity, but many of the same poor diet choices also add risk for weaker bones.
A diet which is low in calcium and vitamin D deprives bones of vital raw materials for bone health. Drinking excess sugar containing soft drinks is already a risk for obesity, but it also is a risk for weaker bones. Soft drinks are high in the mineral phosphorous which binds calcium and make it unavailable for building bones.
Eating a bone healthy diet is not a full guarantee for good bone health. Digestive conditions such as celiac disease, inflammatory bowel disease, or liver disorders damage the intestines ability to absorb calcium and vitamin D properly.
Loss of mobility from neuromuscular conditions such as spina bifida, cerebral palsy, and muscular dystrophy, and spinal cord injury with paralysis remove the important positive effect of movement and standing on bone health. Most children with these conditions have weaker bones.
There are a number of rare genetic conditions, osteogenesis imperfecta being the most recognized, that are linked to weak bones and frequent bone breaks. A key clue often seen with a genetic condition causing weak bones is early appearance of broken bones, sometimes even before birth.
Lastly, certain medications can have a negative impact on bones. Glucocorticoids like prednisone are used to treat inflammation in the body. However, long-term use of this group of medication weakens bones. There are now recent reports of osteoporosis in adults with excessive use of proton-pump inhibitors which treat acid reflux. It’s not known yet if the same risk might happen in children.
2. When should a parent worry about a child’s broken bone?
Children who are already at risk for a broken bone need close monitoring and prevention treatment with calcium and vitamin D.
There are several expert recommendations on investigating broken bones in otherwise healthy children. A child needs further investigation if he or she has any of the following in their bone health history:
- Two long bone fractures before age 10.
- Three long bone fractures before age 19.
- Any vertebral collapse fractures.
3. How is bone health checked in children?
A careful medical history and examination are important first steps in determining risk for a child. Lab tests, both blood and urine, measure important levels in the body including calcium and vitamin D.
A special X-ray test called a DXA scan is used to measure the calcium content in bone and is an important step in determining bone health and risk for fracture. Interpreting the DXA results in children is more challenging than in adults and requires a pediatric specialist with expertise.
4. What can a parent do to insure healthy bones in their child?
Make sure your child has plenty of calcium and vitamin D in his or her diet. Milk and dairy are the prime sources of calcium in the diet. Three servings of dairy per day is important for children 4-8 years old. For the lactose intolerant child, there are lactose-free alternatives available which deliver necessary calcium. A parent should speak with their child’s doctor about calcium and vitamin D supplements if continued concerns about adequate amounts in the diet.
Get your child outside and get them moving. Sunlight exposure is key in the body’s internal production of vitamin D (but wear sunscreen). Movement of muscles, running, and just standing all help stimulate building of healthy, strong bone.
Contact your child’s doctor if he or she has a medical condition putting bone health at risk or if there are unexplained bone pain or fractures.
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. Follow him on Twitter: @The Endoguy.