Objectives Rickets is a disease of growing children with potentially serious short and long-term complications.

The United Kingdom (UK) national incidence of rickets is unknown and thought to be increasing. This study aims to describe the incidence, presentation 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 22 months of surveillance, 89 cases met the case definition. There was little difference by sex. Most were young children, of African and South Asian ethnicity and on solids with dairy. At the time of diagnosis 84% of children were not receiving vitamin D supplements. Cows milk protein allergy and/or multiple food allergies (10% ;9/89) and iron deficiency (7%; 6/89) were the commonest associated conditions. Bony (wrist swelling, bowed legs) and radiological abnormalities were the commonest presentation. Eight children (9.5%) had associated fractures. All confirmed radiological cases had either high parathyroid hormone and/or low phosphate. One child died of dilated cardiomyopathy. There is huge variability in management practices of Vitamin D deficiency amongst clinicians.

Conclusions Interim findings are that rickets continues to affect children in the UK with serious sequelae. Uptake of vitamin D supplementation remains low and constitutes a failure of current public health guidance and policy. We recommend performing both radiographs and biochemical tests for accurate case ascertainment. This is the first national surveillance of nutritional rickets and will provide robust and current data to inform UK national policy on management of this preventable condition.