Aims Vitamin D deficiency is an increasing problem within the UK, particularly in high-risk groups. Clinical manifestations include seizures and cardiomyopathy in infants, muscle weakness, non-specific abdominal pain, poor growth and rickets. Current recommendations are that all children from six months to five years of age receive 7 – 8.5 micrograms of vitamin D per day (Department of Health and Chief Medical Officers). The British Paediatric and Adolescent Bone Group advocate that exclusively breastfed infants receive vitamin D supplements from soon after birth.

The Government’s ‘Healthy Start’ programme aims to prevent deficiency by providing multivitamins (A, C and D) free to families on income support. Some Clinical Commissioning Groups (CCGs) fund these vitamins beyond the scheme - in the case of our own CCG, this is for all children aged 6 months – 3 years inclusive.

Healthy Start vitamins have been available within our ED for some time, with a poster campaign in the ED waiting room encouraging parents/carers to request them. In view of our particular high risk populations, and the large number of cases of vitamin D deficiency diagnosed within our ED, we sought to optimise the provision of Healthy Start vitamins.

Methods Our ED documentation card was modified to prompt the nurse/clinician to routinely ask parents/carers of infants and children 3 years and below if they were currently receiving multivitamins. When this was not the case, a bottle of the Healthy Start vitamin drops was offered, together with a written information booklet about the scheme.

We compared the number of bottles of vitamins supplied before and after this change, by reviewing the logsheet entries for each issue.

Results Number of patients receiving Healthy Start vitamins:

Conclusion Patient attendances to EDs provide opportunities for clinicians to support national health promotion campaigns. This can be optimised by incorporating health promotion questions as a standard aspect of clinical care. The next stage of this initiative will be an audit of the new multivitamin process, to ensure that all eligible patients have been targeted, and to exclude a “drop-off” in compliance.