Rickets Q&As
Published by Bupa's health information team, November 2008.
Answers to questions about rickets
This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.
- I thought rickets had been wiped out in the UK; how has it re-emerged?
- How can I find out if my child is eligible for free vitamin D supplements?
- Is there a danger of giving my child too much vitamin D?
I thought rickets had been wiped out in the UK; how has it re-emerged?
Nutritional rickets has returned to the UK in recent years. This has mainly been in children from ethnic groups (eg Asian, African Caribbean and Middle Eastern).
Explanation
Nutritional rickets had been largely wiped out in the UK thanks to the introduction of food fortification in the 1940s (vitamin D was added to margarine and some breakfast cereals). However, in the 1970s, as more people from different ethnic groups (such as Asian, African Caribbean and Middle Eastern) immigrated to the UK, it reappeared. The Government did get this under control by introducing health campaigns and giving away free vitamin D supplements to children at risk. However, over the last few decades these measures have been relaxed, and rickets has begun to reappear.
Children of Asian, African Caribbean and Middle Eastern origin are more likely to get rickets because their skin is darker. Children with dark skin need a lot more sunlight to get enough vitamin D than those with light skin. The sun in the UK is not strong enough to give these children the amount of vitamin D they need, especially during the winter months when the sun is much weaker. These children need far more exposure to the sun than those with light skin; in the UK it's often not possible for these children to get all the sun exposure they need. Also, some cultures require teenagers to be completely covered; this can mean that they don't get any sunlight.
However, nutritional rickets hasn't only been seen in children of Asian, African Caribbean and Middle Eastern origin in recent years, it has also been found in Western children. Children who don't go outside very often or who wear very high factor sunscreen when they are outside, may also be at risk of developing rickets.
Another major cause of rickets is a diet lacking in vitamin D and calcium. If your child has a poor or restrictive diet, they may miss out on these vital nutrients. If this is coupled with limited exposure to the sun, he/she may be at a greater risk of developing rickets.
There are several steps you can take to prevent your child from getting rickets.
- Make sure he/she gets plenty of calcium and vitamin D in their diet. Good sources of calcium include dairy products (eg milk, yoghurt and cheese), bread (made with fortified flour) and dried fruits. Vitamin D can be found in oily fish, eggs (cooked, not raw), margarine (fortified with vitamin D) and breakfast cereals (fortified with vitamin D).
- Most of the vitamin D your child needs comes from the sun, so take him/her outside to play. However, you need to exercise some caution as babies and young children have very sensitive skin and can burn easily. It's important to keep your child out of the sun between 11am and 3pm, use sunscreen and keep him/her mostly covered (children with light skin only need about 15 minutes of sun on their hands or face two to three times a week).
- Give your child vitamin D supplements. The Department of Health recommends that all children under the age of five should take supplements containing seven micrograms of vitamin D a day. This is especially important for babies who are breastfed or children in at-risk minority groups (eg Asian, African Caribbean and Middle Eastern).
Further information
- British Nutrition Foundation
www.nutrition.org.uk - Department of Health
www.dh.gov.uk
Sources
- Allgrove J. Is nutritional rickets returning? Arch Dis Child, 2004. 89: 699-701
- Primary vitamin D deficiency in children. Drug and Therapeutics Bulletin, 2006. 44: 12-16
How can I find out if my child is eligible for free vitamin D supplements?
In the UK, the Government recommends that all children under the age of five should take vitamin D supplements (amongst others) to prevent rickets. For some children these can be obtained free of charge under the Welfare Foods Scheme (WFS).
Explanation
Babies and children need a healthy balanced diet to help them grow and develop; there are certain nutrients that are essential for this growth. To prevent your child developing rickets, the Department of Health recommend that all children under the age of five take supplements containing seven micrograms of vitamin D a day. This is especially important for babies who are breastfed or children in at-risk groups (eg Asian, African Caribbean and Middle Eastern).
The Government runs a Welfare Foods Scheme (WFS) in which some families can receive supplements free of charge, this includes vitamin D. The scheme can also provide free vitamin D supplements for women who are pregnant or breastfeeding.
You qualify for the WFS if you or your family are:
- receiving income support or income based job seekers allowance, and are pregnant and/or have a child under the age of five
- receiving Pension Credit guarantee credit and are pregnant
- receiving child tax credit and have a family income below a certain limit, and have a child under 5
- have a child with a learning and/or physical disability aged 5 to 16 who is not at school
If you don't qualify for the WFS, you can buy vitamin D supplements from your pharmacist. For babies and children, these can be bought as drops instead of tablets. Always read the patient information leaflet that comes with your supplements.
Further information
- Directgov
0800 056 2665 (WFS helpline)
www.direct.gov.uk
Sources
- Healthy eating for under fives. Directgov. www.direct.gov.uk, accessed 25 March 2008
- Primary vitamin D deficiency in children. Drug and Therapeutics Bulletin, 2006. 44: 12-16.
- Free milk and vitamins: A guide for families. Department of Health. www.dh.gov.uk, accessed 25 March 2008
Is there a danger of giving my child too much vitamin D?
When giving your child vitamin D supplements, it's very important that you follow the Government recommended amounts or your doctor's advice. If you give your child too much vitamin D he/she can end up with vitamin D toxicity which can be harmful to their health.
Explanation
The Government recommends that all children under the age of five should take seven micrograms of vitamin D supplements a day. For pregnant or breastfeeding women, they recommend 10 micrograms daily. These are relatively small amounts, and combined with what you or your child get from their diet and sunshine, will not cause any harm. However, taking more than the recommended amount of vitamin D supplements can result in vitamin D toxicity.
Too much vitamin D can result in you or your child developing very high levels of calcium in their body (hypercalcaemia). This happens because vitamin D helps your body to absorb calcium from your diet; too much vitamin D can cause too much calcium to be absorbed in your body. Hypercalcaemia can cause irreversible kidney failure. Symptoms of hypercalcaemia can include:
- thirst
- constipation
- increased urination
If you or your child are taking vitamin D supplements and have any of these symptoms, you should see your GP.
If your child is receiving treatment from your GP or paediatrician for rickets, the amounts of vitamin D prescribed may be higher than those recommended by the Government. This is because your child's condition needs to be treated and brought under control. In this case, it's very important that you closely follow your GP or paediatrician's instructions.
You can buy vitamin D as part of a multivitamin, rather than a supplement on its own. If you give your child multivitamins, it's important that they take one appropriate for their age. If you are pregnant, be careful about taking multivitamins as they may contain vitamin A which can be harmful to your unborn baby.
Further information
- Department of Health
www.dh.gov.uk - Food Standards Agency
www.eatwell.gov.uk
Sources
- Primary vitamin D deficiency in children. Drug and Therapeutics Bulletin, 2006. 44: 12-16
- When you're pregnant. Food Standards Agency. www.eatwell.gov.uk, accessed 25 March 2008
- Vitamin D toxicity. GP Notebook. www.gpnotebook.co.uk, accessed 25 March 2008
Related topics
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: November 2008
Rickets factsheet
Visit the rickets health factsheet for more information.
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