FOR STRON

FOR LI FE LON

U.S. DEPARTMENT O

National Institutes of H

National Institute of C
Dear Reader, 

Milk Matters is for parents, teachers, 

and health care providers of girls and 

boys ages 11 to 15, a time of critical 

bone growth. However, the information 

also applies to younger and older kids 

because calcium is important throughout 

life for strong bones and a healthy 

body. Fewer than one in 10 girls and 

only one in four boys ages 9 to 13 

are at or above their adequate intake 

of calcium.* But the good news is 

that you can help young people 

get enough calcium, and the 

benefits will last a lifetime. We 

hope this booklet will help you 

learn more about milk and 

calcium so you can help your 

children and teenagers grow 

into strong, healthy adults. 

Sincerely yours, 

Duane Alexander, M.D. 

Director, National Institute of Child 


Health and Human Development (NICHD)
 

*USDA, ARS, 2005. What We Eat in America, NHANES 2001-2002. 

TABLE OF CONTENTS 

Growing needs for milk 2 

Who needs the most calcium? 3 

Physical activity builds 


strong bones 4
 

Calcium and a healthy mouth 5
 

Sources of calcium 6
 

If your child says “Yuck!” 8
 

Is all milk the same? 9
 

Milk and digestive problems 10
 

Calcium on the menu 12
 

Enjoy milk, 


so your children will. 13
 
Growing tweens* and teens 

have growing needs for milk. 

It takes calcium to build strong bones. And calcium is especially 

important during the tween and teen years, when bones are 

growing their fastest. Boys and girls in these age groups have 

calcium needs that they can’t make up for later in life. Tweens and 

teens can get most of their daily calcium from 3 cups of low-fat 

or fat-free milk (900 mg of calcium), but they also need additional 

servings of calcium-rich foods to get the 1,300 mg of calcium 

necessary to build strong bones for life. 

Low-fat or fat-free milk is a great source of calcium because it also 

has other important nutrients that are good for bones and teeth. 

One especially important nutrient is vitamin D, which helps the 

body absorb more calcium. 

*Note: Tweens are kids ages 9 to 12. 

Babies aren’t the ones 

who need the most calcium. 

Starting around age nine, young people need almost twice 

as much calcium as younger kids to help during the critical 

bone-building time between the ages of 11 and 15. Unfortunately, 

fewer than one in 10 girls and only one in four boys ages 9 to 13 

are at or above their adequate intake of calcium. 

Daily calcium needsby age: 

Birth to 6 months 210 mg 

6 to 12 months 270 mg 

1 to 3 years 500 mg 

4 to 8 years 800 mg 

9 to 18 years 1,300 mg 

= 300 mg 

3 

Source: Dietary Reference Intakes for Calcium, National Academy of Sciences, 1997. 

2 
5 

Building strong bones 

in the tween and teen years 

makes a lifelong difference. 

Having a calcium-rich diet when you’re young makes a big difference 

in health, now and later. By getting the calcium they need now, tweens 

and teens will: 

• Strengthen bones now. Our bodies continually remove and replace 

small amounts of calcium from our bones. If more calcium is removed 

than is replaced, bones will become weaker and have a greater chance 

of breaking. Some researchers suspect that the rise in forearm 

fractures in children is due to decreased bone mass, which may result 

because children are drinking less milk and more soda and are getting 

less physical activity. 

• Help prevent osteoporosis later in life. Osteoporosis is a condition 

that makes bones weak so they break more easily. Although the effects 

of osteoporosis might not show up until adulthood, tweens and teens 

can help prevent it by building strong bones when they are young. 

Calciumkeepsmouthshealthytoo.

Calcium is important for a healthy mouth too. Even before they 

come in, baby teeth and adult teeth need calcium to develop 

fully. And after the teeth are in, calcium may also help protect 

them against decay. Calcium makes jawbones strong and 

healthy too! 

Besides making sure your children get enough calcium, 

there are other things you can do to keep their teeth healthy: 

• Make sure your children brush with a fluoride toothpaste. 

Fluoride protects teeth from decay and helps heal early 

decay. 

• Ask your child’s dental care or health care provider if there 

is fluoride in your town or city’s drinking water. If there is 

not, ask about fluoride tablets or drops for your child. 

• Ask your child’s dental care provider about proper brushing 

and flossing techniques and other ways your tween or teen 

can make sure teeth stay healthy. 

Bones are living tissue. Weight-bearing physical activity causes 

new bone tissue to form, which makes bones stronger. This kind 

of physical activity also makes muscles stronger. When muscles 

push and tug against bones during physical activity, bones and 

muscles become stronger. 

Weight-bearing activities are those that keep you active and on 

your feet so that your legs carry your body weight. Activities 

such as walking, running, dancing, climbing stairs, and playing 

team sports like basketball, soccer, and volleyball help make 

bones stronger. Older teenagers can build even more bone 

strength through weight training, but they should check with 

a health care provider before starting any type of training. 

Some activities, such as swimming, do not provide weight-bearing 

benefits. But they are good for cardiovascular fitness and 

overall good health. 

Weight-bearingphysicalactivityalsobuildsstrongbones.

4 
7 

Here’s where tweens and teens 

can get the calcium they need. 

These foods help tweens and teens reach the 1,300 mg 

of calcium they need every day. 

Calcium-Rich Foods 

Food Serving 

Size 

Calories 

Amount 

of Calcium

Plain yogurt, fat-free 1 cup 127 452 mg 

Orange juice 

with added calcium 

8 fluid 

ounces 

(1 cup) 120 350 mg 

Fruit yogurt, low-fat 1 cup 232 345 mg 

Ricotta cheese, part skim 1/2 cup 170 334 mg 

American cheese, 

low-fat and fat-free 

2 ounces 

(about 

3 slices) 

(Calories 

vary) 312 mg 

Milk (fat-free, low-fat, 

whole, or lactose-free) 

8 fluid 

ounces 

(1 cup) 

(Calories 

vary) 300 mg 

Soybeans, cooked 1 cup 175 298 mg 

Cheddar cheese, 

low-fat and fat-free 1/2 cup (Calories 

vary) 204 mg 

Tofu, firm, with added 

calcium sulfate 1/2 cup 97 204 mg 

Soy beverage 

with added calcium 

8 fluid 

ounces 

(1 cup) 

100-130 

200-300 mg 

Cheese pizza 1 slice 240 200 mg 

= 100 mg 

There are lots of different calcium-rich foods to choose from, making 

it easy for tweens and teens to get the calcium they need every day. 

For example, just 1 cup of yogurt gives young people 25 percent of 

their daily calcium requirement. Low-fat and fat-free milk and milk 

products, such as low-fat or fat-free cheese and yogurt, are also 

excellent sources of calcium. Remember: tweens and teens can get 

most of their daily calcium from 3 cups of low-fat or fat-free milk 

(900 mg of calcium), but they also need additional servings of calciumrich foods to get the 1,300 mg of calcium necessary. 

Food labels can tell you how much calcium is in one serving of food. Look 

at the % Daily Value (% DV) next to the calcium number on the food label. 

For more information, go to http://vm.cfsan.fda.gov/~dms/foodlab.html. 

Here are some other foods young people can eat to boost 

their calcium intake. 

Other Foods with Calcium 

Food Serving 

Size 

Calories Amount 

of Calcium

Broccoli, raw 1 medium stalk 106 

180 mg 

Broccoli, cooked 1 cup 52 94 mg 

Bok choy, boiled 1 cup 20 158 mg 

Spinach, cooked 

from frozen 1/2 cup 27 

139 mg 

Frozen yogurt, 

softserve vanilla 1/2 cup 114 103 mg 

Macaroni and cheese 1 cup 230 100 mg 

Almonds 1 ounce 

(22 nuts) 169 75 mg 

Tortilla, flour (7-8 inches) 1 tortilla 150 58 mg 

Tortilla, corn (6 inches) 1 tortilla 53 42 mg 

= 100 mg 

6 

Sources: USDA National Nutrient Database for Standard 

Reference, Release 17; Bowes and Church’s Food Values 

of Portions Commonly Used, 2005. Some values have 

been rounded. 
9 

“But my child doesn’t like 

the taste of milk!” 

Even if your tweens or teens don’t like the taste of plain milk, 

there are still plenty of ways to get calcium in the diet: 

• Try a flavored low-fat or fat-free milk, such as chocolate, vanilla, 

or strawberry. Flavored milk has just as much calcium as plain. 

• Serve foods that go with milk, such as fruit bars and fig bars. 

• Drink milk or yogurt smoothies for breakfast or a snack. 

You can make these at home or try one of the ready-made 

versions now available at many grocery stores. 

• Keep portable, calcium-rich foods on hand for snacks 

on the run, such as low-fat or fat-free string cheese 

or individual pudding cups with calcium added. 

• In moderation, low-fat or fat-free ice cream and frozen 

yogurt are calcium-rich treats. 

• Serve non-milk sources of calcium, such as calcium-fortified 

soy beverages or orange juice with added calcium. 

• Try a spinach salad or have fresh or cooked broccoli. 

Is one type of milk better 

than the other? 

Today, tweens and teens have more milk choices than ever before. 

Most types of milk have approximately 300 mg of calcium per 8 fluid 

ounces (1 cup) – about 25 percent of the calcium that children and 

teenagers need every day. The best choices are low-fat or fat-free 

milk and milk products. Because these items contain little or no fat, 

it’s easy to get enough calcium without adding extra fat to the diet. 

Chocolate and other flavored milks have just as much calcium as plain 

milk, so it is fine for young people to drink these options if they prefer 

the taste. Remember to choose low-fat or fat-free. 

Low-fatorfat-freemilkisbestfortweensandteens.

Whole

Milk

8 grams fat 

Low-fat

Milk

2.5 grams fat 

Fat-free

Milk

0 grams fat 

Children one to two years old should drink whole milk. After age 

two, low-fat or fat-free milk should become their regular drink. 

Source: Dietary Guidelines for Americans, 2005. 

Fat-free 

8 
11 

What if milk causes 

digestive problems? 

This happens in some children (and adults) who have 

lactose intolerance. These people may have trouble 

digesting lactose, the natural sugar found in milk and 

milk products. Symptoms of lactose intolerance include 

stomach pain, diarrhea, bloating, and gas. 

The best way for these people to get the health benefits 

of milk is to choose lactose-free milk and milk products. 

There is also a variety of pills and drops, which are available 

without a prescription, that help people digest lactose. 

In addition, most people who have problems digesting 

lactose can usually eat or drink: 

• 8 fluid ounces (1 cup) of low-fat or fat-free milk 

taken with meals 

• Low-fat or fat-free yogurt or cheese 

• Low-fat or fat-free milk poured on hot or cold cereal 

People who have problems digesting lactose can also get some of 

their needed calcium from dark green vegetables, such as spinach, 

broccoli, and bok choy. Foods with calcium added are also 

an option. Be sure to check the ingredient list for calcium in: 

• Tofu with added calcium sulfate 

• Orange juice with added calcium 

• Soy or rice beverages with added calcium 

• Calcium-fortified breakfast cereals or breads 

Calcium supplements also provide an alternative way 

of getting calcium. 

Lactose intolerance is not common among children. However, 

if your children have problems with lactose, talk to their health 

care provider. 

The tween and teen years are an 

important time for young people 

to learn smart eating habits that 

will last a lifetime. Making low-fat 

or fat-free milk and other 

calcium-rich foods a part of the 

diet now teaches tweens and 

teens to make healthy choices. 

And learning to make healthy 

food choices at home will carry 

over into school and adulthood. 

“Makingitmilk”canleadtolifelonghealthyeating.

10 
13 

Put calcium on the menu 

at every meal. 

One way to make it easier for tweens and teens to get enough calcium 

is to serve low-fat or fat-free milk and other calcium-rich foods throughout 

the day. Putting calcium-rich foods on your family’s menu at each meal 

is also a great way to make sure that everyone gets the calcium they need. 

When milk is the main beverage in the home, tweens and teens will 

choose it more often. 

Ideas for calcium-rich meals and snacks 

Breakfast Lunch Snack Dinner 

• Pour low-fat • Add low-fat • Make a smoothie • Make a salad 

or fat-free milk 

over your 

breakfast cereal. 

• Have a cup 

of low-fat or 

fat-free yogurt. 

• Drink a glass of 

orange juice with 

added calcium. 

• Add low-fat 

or fat-free milk 

instead of water 

to oatmeal 

and hot cereal. 

or fat-free 

cheese to 

a sandwich. 

• Have a glass 

of low-fat or fatfree milk instead 

of soda. 

• Have a pizza 

or macaroni 

and cheese. 

• Add low-fat 

or fat-free milk 

instead of water 

to tomato soup. 

with fruit, ice, 

and low-fat 

or fat-free milk. 

• Try flavored lowfat or fat-free milk 

like chocolate 

or strawberry. 

• Have a low-fat 

or fat-free 

frozen yogurt. 

• Try some pudding 

made with low-fat 

or fat-free milk. 

• Dip fruits and 

vegetables into 

low-fat or fat-free 

with dark green, 

leafy vegetables. 

• Serve broccoli 

or cooked, dry 

beans as 

a side dish. 

• Top salads, 

soups, and stews 

with low-fat or 

fat-free shredded 

cheese. 

• Toss tofu with 

added calcium 

to stir fry and 

other dishes. 

yogurt. 

• Have some low-fat 

or fat-free string 

cheese. 

Source: American Dietetic Association’s Complete Food and Nutrition Guide, 1996. 

If you enjoy milk, chances are 

your children will, too. 

Tweens and teens look up to their parents and want to be like them. 

Young people make many food choices by watching their parents, 

so if you want your children to enjoy the bone-building benefits 

of at least 3 cups of low-fat or fat-free milk and milk products every 

day, show it. Drink milk yourself, and offer calcium-rich meals 

and snacks. This is the best way to show tweens and teens that 

Milk Matters! 

Teachersandotheradultscanspread

thewordaboutcalcium,too.

As a teacher or activity leader, you play • Include calcium in lesson plans on 

an important role in teaching 11- to 15­ health or nutrition labels. 

year-olds the importance of getting at • Have students keep a log of their 

least 3 cups of low-fat or fat-free milk daily calcium intake. Use it to create 

a day, plus other calcium-rich foods. a contest between students or 

Here are some ways you can help spread classrooms to see who can consistently 

the word: meet their daily calcium intake the 

most days in a row. • Hang a copy of the Milk Matters poster 

in your classroom. To order your • Visit the Milk Matters Web site 

free copy, call 1-800-370-2943 for additional resources 

or visit http://www.nichd.nih.gov/milk. http://www.nichd.nih.gov/milk. 

12 
NICHD Information 

Phone: 1-80

TTY: 1-888

Fax: (301) 

Mail: P.O. Box 3006, 

E-mail: NICHDInformationRe

Internet: http://www

NIH Publicatio

Septemb