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BMJ. 2007 June 23; 334(7607): 1288.
PMCID: PMC1895680
Rickets

Prevention message is not getting through

Scott Williamson, specialist registrar and Stephen Greene, consultant paediatrician

Ten years ago vitamin D deficient rickets was diagnosed in six children in Manchester, which highlighted the need to implement the government's policy on vitamin D supplementation.1 In Tayside in the past four months we have diagnosed vitamin D deficient rickets in five infants in an almost identical scenario. None of these children or mothers had received vitamin D supplementation. Their families were unaware of the need for this, despite the UK government recommendations for the universal use of vitamin supplements to all breastfeeding infants to prevent rickets, which have existed for over 10 years.2 This recommendation is particularly important for those of Asian, African, Afro-Caribbean, or Middle Eastern origin with reduced exposure to sunlight.3

The public is not receiving this message so clearly. The NHS Direct website is not specific and is ambiguous about the need for vitamin supplements (www.nhsdirect.nhs.uk/articles/article.aspx?articleId=1122). The recommendations are laid out more clearly as a component of the “Healthy Start” initiative (www.healthystart.nhs.uk), which has replaced the welfare food scheme, but the uptake of vitamins was particularly low when this scheme was last audited.4 None of the affected families we saw is eligible for this scheme as it is mainly directed at poor and disadvantaged people, and not specifically immigrant groups.

The Scientific Advisory Committee on Nutrition has just published a position statement on vitamin D, with particular reference to preventing rickets, in which the need for a public health campaign on the issue is highlighted and the need to supplement infants in high risk groups with vitamin D emphasised.5 The signs and symptoms of rickets were recognised by the general practitioner in only one of the cases we saw. It is now imperative to disseminate the message to all health visitors and general practitioners across the UK.

Notes

Competing interests: None declared.

References

1. Mughal MZ, Salama H, Greenaway T, Laing I, Mawer EB. Lesson of the week: Florid rickets associated with prolonged breast feeding without vitamin D supplementation. BMJ 1999;318:39-40. [PMC free article] [PubMed]
2. HMSO. Department of Health COMA report on weaning and the weaning diet. 1994. Report No.: 45.
3. Callaghan AL, Moy RJD, Booth IW, Debelle G, Shaw NJ. Incidence of symptomatic vitamin D deficiency. Arch Dis Child 2006;91:606-7. [PMC free article] [PubMed]
4. Department of Health. Scientific review of the welfare food scheme London: Stationery Office, 2002
5. Scientific Advisory Committee on Nutrition. Update on vitamin D Position statement, 2007

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