No Bones About It: Questions and Answers About Nutrition, Epilepsy and Bone Health

By Ellen Sviland Avery, MS, RD, LD, CNSC

Why should I be worried about my child’s bones?

Bone health is important for men and women, children and adults. As children, it is important to get enough calcium and Vitamin D starting during infancy. Inadequate calcium and Vitamin D during childhood can affect proper bone development.

Where can I find calcium and Vitamin D in my food?

Good sources of calcium include dairy products, calcium fortified orange juice and milk substitutes, sardines, dark green leafy vegetables (kale, spinach, collard greens) and calcium fortified cereals. Good sources of Vitamin D include salmon, tuna, shrimp, egg yolks, beef liver, mushrooms and Vitamin D fortified foods. Of note, Vitamin D can also be made in the liver from sunlight!

How much calcium and Vitamin D does my child need daily?

The Recommended Dietary Allowance for calcium for children aged 1-3 years is 700 mg/day, 4-8 years is 1000 mg/day, and 9-18 years of age is 1300 mg/day. For Vitamin D, the RDA for children aged 1-18 years is 600 international units (IU) per day.

How do I know if there’s a deficiency?

If you are concerned about a deficiency, be sure to discuss it with your child’s health care provider.

What does this have to do with my child with seizures?

Many common anti-epileptic drugs (AED) can cause disturbances with Vitamin D absorption. In a recently published study, decreased bone mineral density was seen more often when a child was on more than one AED (Vestergaard 2015). As we mentioned already, Vitamin D is necessary for good bone health. It is important to talk to your physician about ensuring your child is receiving adequate Vitamin D and calcium.

Now you might ask why we are focusing on bone health and the ketogenic diet. Typically, the ketogenic diet can be low in high calcium and Vitamin D foods as many of them contain carbohydrate, which is restricted in the ketogenic diet. The effect of diet on bone health is just one of the many reasons why it is so important to use the ketogenic diet only under medical and nutritional supervision. Your physician and dietitian that are helping you to manage your child’s ketogenic diet will help to ensure they are meeting the recommended dietary allowance’s (RDA’s) for calcium and Vitamin D. Most often, they will recommend a calcium and Vitamin D supplement to make up for any gaps in the diet. They may also check blood levels to look out for deficiencies in calcium or Vitamin D.

Again, if you have any concerns about your child’s diet and bone health, be sure to discuss it with your child’s health care team.


1. Vestergaard P. Effects of Antiepileptic Drugs on Bone Health and Growth Potential in Children with Epilepsy. Paediatr Drugs. 2015.