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 milk2

Who needs the most calcium?3

Physical activity builds 

strong bones4

Calcium and a healthy mouth5

Sources of calcium6

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
2

3

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.

6 to 12 months 270 mg

Birth to 6 months 210 mg

1 to 3 years 500 mg

4 to 8 years 800 mg

9 to 18 years 1,300 mg

Daily calcium needs by age:

= 300 mg

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

Calcium keeps mouths healthy too. 

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-bearing physical activity also builds strong bones.

5

4
6

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.

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.

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.

7

Food

Plain yogurt, fat-free

Orange juice 

with added calcium

Fruit yogurt, low-fat

Ricotta cheese, part skim

American cheese, 

low-fat and fat-free

Milk (fat-free, low-fat, 

whole, or lactose-free)

Soybeans, cooked

Cheddar cheese, 

low-fat and fat-free

Tofu, firm, with added

calcium sulfate

Soy beverage 

with added calcium

Cheese pizza

Serving

Size

1 cup

8 fluid

ounces

(1 cup)

1 cup

1/2 cup

2 ounces

(about

3 slices)

8 fluid

ounces

(1 cup)

1 cup

1/2 cup

1/2 cup

8 fluid

ounces

(1 cup)

1 slice

Amount

of Calcium Calories

127

120

232

170

(Calories

vary)

(Calories

vary)

175

(Calories

vary)

97

100-130

240

Calcium-Rich Foods

452 mg

350 mg

345 mg

334 mg

312 mg

300 mg

298 mg

204 mg

204 mg

200-300 mg

200 mg

= 100 mg

Food

Broccoli, raw

Broccoli, cooked

Bok choy, boiled

Spinach, cooked 

from frozen

Frozen yogurt, 

softserve vanilla

Macaroni and cheese

Almonds

Tortilla, flour (7-8 inches)

Tortilla, corn (6 inches)

Serving

Size

1 medium stalk

1 cup

1 cup

1/2 cup

1/2 cup

1 cup

1 ounce

(22 nuts)

1 tortilla

1 tortilla

Amount

of Calcium Calories

106

52

20

27

114

230

169

150

53

Other Foods with Calcium

= 100 mg

180 mg

94 mg

158 mg

139 mg

103 mg

100 mg

75 mg

58 mg

42 mg
9

8

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.

“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.

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.

8 grams fat 2.5 grams fat 0 grams fat

Fat-free

Milk

Low-fat

Milk

Whole

Milk

Low-fat or fat-free milk is best for tweens and teens.
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.

“Making it milk” can lead to lifelong healthy eating.

10
13

12

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

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!

Breakfast

• Pour low-fat 

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.

Lunch

• Add low-fat 

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.

Snack

• Make a smoothie

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

yogurt.

• Have some low-fat

or fat-free string

cheese.

Dinner

• Make a salad

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.

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

As a teacher or activity leader, you play

an important role in teaching 11- to 15-

year-olds the importance of getting at

least 3 cups of low-fat or fat-free milk 

a day, plus other calcium-rich foods. 

Here are some ways you can help spread

the word:

• Hang a copy of the Milk Matters poster

in your classroom. To order your 

free copy, call 1-800-370-2943

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

• Include calcium in lesson plans on

health or nutrition labels. 

• Have students keep a log of their 

daily calcium intake. Use it to create 

a contest between students or 

classrooms to see who can consistently

meet their daily calcium intake the 

most days in a row.

• Visit the Milk Matters Web site 

for additional resources

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

Teachers and other adults can spread

the word about calcium, too.
NICHD Information 

Phone: 1-80

TTY: 1-888

Fax: (301) 

Mail: P.O. Box 3006, 

E-mail: NICHDInformationRe

Internet: http://www

NIH Publicatio

Septemb