Calcium Intake for a 5-Year-Old After Femur Fracture Surgery
A 5-year-old child recovering from femur fracture surgery with flexible intramedullary nailing should receive 1,000 mg of elemental calcium daily through diet and supplementation if needed, combined with 600 IU of vitamin D daily. 1
Recommended Daily Calcium Intake
The Institute of Medicine guidelines, while not specifically addressing the exact age of 5 years in the provided evidence, establish that children ages 4-17 years treated with glucocorticoids require 1,000 mg/day of calcium. 1 This recommendation applies to pediatric fracture patients as adequate calcium intake is essential for bone healing and skeletal health at all ages. 1
Vitamin D Co-Administration
Calcium supplementation must be paired with vitamin D at 600 IU/day for children ages 4-17 years. 1 This combination is critical because:
- Vitamin D enhances calcium absorption and utilization for bone healing 1
- The combination reduces fracture risk more effectively than calcium alone 2, 3
- Vitamin D alone without adequate calcium provides no fracture reduction benefit 2
Preferred Sources and Delivery
Calcium-rich foods and beverages, particularly dairy products, should be the primary source rather than supplements. 1 To estimate dietary calcium intake:
- Most children consume approximately 300 mg of calcium daily from non-dairy sources (vegetables, grains) 1
- Calculate additional intake from dairy products to reach the 1,000 mg target 1
- Only supplement if dietary intake is inadequate to meet the 1,000 mg daily requirement 1
Supplement Formulations (If Needed)
If supplementation is necessary because dietary intake falls short:
- Calcium carbonate (40% elemental calcium) is the least expensive and most commonly used, but must be taken with meals for optimal absorption 1
- Calcium citrate (21% elemental calcium) does not require meal timing and may be preferable if absorption is a concern 1
- Divide doses throughout the day rather than single large doses for better absorption 1
Upper Safety Limits
Do not exceed 2,500 mg of elemental calcium per day in children, as higher amounts increase risk of adverse effects including nephrolithiasis. 1 Common side effects of calcium supplements include constipation and bloating. 1
Duration and Monitoring
Continue calcium and vitamin D supplementation throughout the fracture healing period, which averages 10.5 weeks for femoral shaft fractures treated with flexible intramedullary nailing in children aged 5-10 years. 4 The typical union time for these fractures is 8-13 weeks. 4, 5, 6
Critical Pitfalls to Avoid
- Do not use calcium supplementation alone without vitamin D, as calcium alone has no demonstrated fracture reduction effect 2, 3
- Do not rely solely on supplementation when dietary sources can meet requirements, as food sources may provide better absorption and fewer side effects 1
- Do not exceed recommended upper limits, particularly the 2,500 mg/day threshold, which increases risk of kidney stones 1
- Do not give calcium carbonate without meals, as gastric acidity is required for optimal absorption of this formulation 1