For over ten years, the UK government has recommended universal use of vitamin supplements to all breastfeeding infants to prevent rickets, write Scott Williamson and Stephen Greene from Ninewells Hospital in Dundee.
Yet, in the past four months, they have diagnosed vitamin D deficient rickets in five infants in Tayside.
None of these children or mothers had received vitamin D supplementation and their families were unaware of the need of this.
The recommendation is particularly important for those of Asian, African, Afro-Caribbean, or Middle Eastern origin with reduced exposure to sunlight, say the authors, as increased skin pigmentation makes it more difficult to synthesise vitamin D.
Vitamin D deficiency can cause rickets, poor tooth formation, convulsions, and stunted growth. It has also been linked to an increased risk of health problems in later life.
The authors argue that the NHS Direct website is ambiguous about the need for vitamin supplements.
The Scientific Advisory Committee on Nutrition has just published a position statement on vitamin D, with particular reference to preventing rickets, which highlights the need for a public health campaign and emphasises the need to supplement infants in high risk groups.
'We must disseminate the message to all health visitors and general practitioners across the UK,' they conclude.
BMJ 2007; 334: 1288.
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