Children 'put at risk of rickets'

"Children 'put at risk of rickets'", BBC News, June 21, 2007,
Link: http://news.bbc.co.uk/2/hi/health/6225450.stm

Children are being put at risk of rickets because policies on vitamin
D supplements are not been adhered to, experts have warned.

Doctors in Dundee write in the British Medical Journal that they
recently diagnosed five infants with rickets - which can stop bones
forming properly.

The government recommends that pregnant women should use vitamin D
supplements.

Babies from Asian, African, Afro-Caribbean or Middle Eastern
backgrounds are particularly at risk.

The paediatricians at Ninewells Hospital in Dundee said none of the
mothers of the five children they had recently diagnosed had received
vitamin D supplements.

They warned parents were unaware of the risk because it was rarely
mentioned by GPs or health visitors.

Government recommendations state that pregnant and breastfeeding
mothers should take vitamin D supplements.

They are also recommended for infants in high-risk groups.

The main source of vitamin D is through ultra-violet radiation in
sunlight, although it can also be found in certain foods.

It is crucial for the absorption of calcium, which is key in the
formation of healthy bones. Deficiencies can lead to rickets, poor
tooth formation, stunted growth and general ill health.

People with darker skin are at greater risk of vitamin D deficiencies
because increased pigmentation reduces the capacity of the skin to
manufacture the vitamin from sunlight.

'Ignorance'

Dr Scott Williamson, specialist registrar at Ninewells hospital, said
there was a lack of awareness in primary care.

"If you try to find official government advice, it's not that easy to
find," he said.

"It may be the government needs to better disseminate the guidance.

"There does seem to be a bit of ignorance - for instance people don't
realise you're more at risk of getting rickets if you're breastfed.

"Also we're failing ethnic groups by not reinforcing the public health
message."

Vitamins are provided for free under the Healthy Start initiative,
which is aimed at low income families on Income Support, Jobseeker's
Allowance or Child Tax Credits.

They are also provided free to pregnant women under the age of 18
years but Dr Willamson said GPs should be prescribing the vitamins
(which can also be bought from the chemist) for all pregnant women.

Dr Tony Williams, consultant in neonatal paediatrics at St George's
Hospital in London, said that when rickets occurred in babies, it was
a sign that the mother was deficient in vitamin D during the last few
months of pregnancy.

"The policy for many years has been that women should receive vitamin
D supplements during pregnancy but hardly any do," he said.

But he said antenatal guidance from the government's drugs watchdog
NICE had concluded that it was not necessary and this had added to the
confusion.

The Scientific Advisory Committee on Nutrition recently published
advice supporting supplementation.