What is the appropriate oral calcium supplementation dose for a healthy 5‑year‑old child?

Oral Calcium Supplementation for a Healthy 5-Year-Old Child

For a healthy 5-year-old child, the recommended total daily calcium intake is 800 mg per day from all sources (diet plus supplements), and supplementation should only be provided if dietary intake is inadequate. 1, 2

Determining the Need for Supplementation

• First, assess dietary calcium intake from milk, dairy products, and calcium-fortified foods before prescribing supplements. 1, 2
• Supplementation is indicated only when dietary intake falls short of the 800 mg/day target for this age group. 1, 2
• The preferred approach is to increase calcium-rich foods rather than rely on supplements. 1, 2

Calculating the Supplementation Dose

If supplementation is needed, calculate the dose as: 800 mg (total daily requirement) minus the child's estimated dietary calcium intake. 1, 2

For example:

• If the child consumes approximately 400 mg calcium from diet, provide 400 mg elemental calcium as a supplement. 1, 2
• If dietary intake is 300 mg, provide 500 mg elemental calcium as a supplement. 1, 2

Choosing the Right Formulation

Calcium carbonate is the most cost-effective and practical choice for pediatric supplementation. 3, 4

Practical Dosing with Calcium Carbonate Products:

• Tums EX (750 mg calcium carbonate = 300 mg elemental calcium per tablet): Give 1–2 tablets daily depending on the calculated deficit. 5, 4
• Tums Ultra (1,000 mg calcium carbonate = 400 mg elemental calcium per tablet): Give 1–2 tablets daily depending on the calculated deficit. 5, 4
• Remember that calcium carbonate is 40% elemental calcium by weight. 3, 5

Administration Guidelines

• Always give calcium carbonate with meals to optimize absorption, as it requires gastric acid for dissolution. 3, 6, 5
• Divide doses if giving more than 500 mg elemental calcium daily; single doses should not exceed 500 mg elemental calcium to maximize absorption efficiency. 6, 7
• Do not administer on an empty stomach, as absorption will be markedly reduced. 6

Safety Limits and Monitoring

• The upper safe limit for total calcium intake (diet plus supplements) in children aged 1–8 years is 2,500 mg/day. 3, 6
• For a 5-year-old, do not exceed 800 mg/day total intake unless there is a specific medical indication (such as nutritional rickets). 1, 2
• Monitor for constipation and bloating, which are the most common side effects of calcium carbonate. 3, 5, 4

Special Clinical Scenarios

If the Child Has Nutritional Rickets:

• Provide 1,000 mg elemental calcium daily (divided into 2–3 doses with meals), which requires approximately 2,500 mg calcium carbonate daily. 6, 8
• This higher dose (1,000 mg elemental calcium) produces more rapid radiographic healing than 500 mg and is as effective as 2,000 mg. 8
• Co-administer with vitamin D to prevent secondary hyperparathyroidism. 6

If the Child Takes Acid-Reducing Medications:

• Switch to calcium citrate instead of calcium carbonate, as citrate does not require gastric acid for absorption. 4, 7

Common Pitfalls to Avoid

• Do not prescribe supplements without first estimating dietary calcium intake; many children may already meet requirements through diet alone. 1, 2
• Do not use calcium supplements in hypercalcemic patients. 6, 4
• Do not give calcium carbonate on an empty stomach, as this dramatically reduces bioavailability. 3, 6
• Do not exceed single doses of 500 mg elemental calcium (approximately 1,250 mg calcium carbonate), as absorption efficiency drops with larger single doses. 6, 7