Background and Aims Rickets is a disease of growing children with serious short and long-term complications. The United Kingdom (UK) national incidence of rickets is unknown. This study aims to describe the presentation, incidence and clinical management of children with Nutritional Rickets in the UK and Republic of Ireland.

Methods Data is being collected prospectively monthly between March 2015–March 2017 from 3500 paediatricians using British Paediatric Surveillance Unit reporting methodology.

Results During 20 months of surveillance, 89 cases met the case definition. There was little difference in the presentation of rickets by sex (males 52% (46/89), females 48% (42/89)). At the time of diagnosis 22% (20/89) were aged <1 year, 42% (37/89) were aged 1–2 years, 27% (24/89)aged 2–5 years, 9% (8/89) 5–15 years. African (30%) and Pakistani (18%) children were a high proportion of the notified cases. Cows milk protein allergy (10%; 9/89) and iron deficiency (7%; 6/89) were the commonest associated conditions. At the time of diagnosis 87% of children were not receiving vitamin d supplements. 9% (8/89)(aged 8 months–14 years) had associated fractures. All confirmed radiological cases had either high parathyroid hormone and/or low phosphate. One child died of dilated cardiomyopathy from vitamin d deficiency Following diagnosis, 39% (43/89 ) of clinicians requested primary care to administer treatment.

Conclusions Surveillance continues to March 2017 but it is clear from the interim findings that rickets continues to affect children in the UK with serious sequelae. Despite national guidance, uptake of vitamin d supplementation remains low and constitutes a failure of current public health policy. As there was good correlation we recommend performing both xray and biochemical tests for accurate case ascertainment. This is the first international surveillance of nutritional rickets and will provide robust and current data to inform UK national policy on management of this preventable disease.