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LETTERS: Scott Williamson and Stephen Greene Prevention message is not getting through BMJ 2007; 334: 1288-a [Full text]

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Vitamin D Deficiency – failing to prevent the preventable

Alice Roueché, Susan Minson, Deborah Hodes   (8 July 2007)

Vitamin D Deficiency – failing to prevent the preventable 8 July 2007
Alice Roueché, Paediatric SpR Worthing Hospital, Susan Minson, Deborah Hodes Send response to journal: Re: Vitamin D Deficiency – failing to prevent the preventable	Response to “Prevention message is not getting through” Williamson, S, Greene S. BMJ. 2007;334:1288 (23 June) We agree wholeheartedly with this letter and would like to support it with the results of a study carried out in the borough of Camden, north London in January 2007 which clearly showed that this important public health message is not getting through. We are continuing to see new diagnoses of rickets at University College London Hospital, illustrating the reimergence of this disease. We investigated whether children in Camden were receiving supplementation in line with government recommendations (1). Following ethical approval, questionnaires were distributed to all mothers attending baby clinics over a six week period at two child health clinics in the UCLH catchment area. Questions asked about age, feeding type, whether vitamin supplements were given, who had recommended them and the ethnic origin. A Bangladeshi interpreter was available to assist parents. Recommendations from Healthy Start (2) were considered best practice and used as the standard and are consistent with advice given to Camden health visitors. 80.6%, (75/93) parents completed the questionnaire. The age of the children ranged from 19 days to 5 years. 46 children were breast or mixed fed, 27 bottle fed and one did not specify. In total 9 parents reported giving their children vitamin supplements, 5 following health visitor recommendation and 3 had them prescribed at discharge from the neonatal unit. One mother had taken advice from a health information poster. Of those not receiving supplements, 26 children were not eligible due to age or feeding type. The remaining 38 eligible children were not taking vitamin supplements despite attending a child health clinic. In summary, only 19.1% (9/47) at risk children were following current guidelines and taking vitamin supplements. It is very clear from these results that we are failing to identify the majority of children who should be receiving supplemental vitamins as recommended by the Department of Health (1,3). It seems likely that this may in part be due to the lack of clear advice and availability of vitamin drops. If we had used the recommendation that all children under 5 years old should receive supplemental vitamin D, then only 7% of our sample were appropriately receiving vitamin supplements. Dr Alice Roueché, Paediatric SpR Dr Susan Minson, Paediatric SHO Dr Deborah Hodes. Consultant Community Paediatrician Department of Community Paediatrics Camden PCT, Greenland Road, London, NW1 OAS References 1. Scientific Advisory Committee on Nutrition. Update on vitamin D. Position statement, 2007 2. www.healthystart.nhs.uk 3. Department of Health Report on Health and Social Subjects. 49 Nutrition and bone health: with particular reference to calcium and vitamin D. ‘Report of the Subgroup on Bone Health, Working Group on the Nutritional Status of the Population of the Committee on Medical Aspects of the Food Nutrition Policy. London HMSO 1998. Competing interests: None declared