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Nutritional rickets under 16 years: UK surveillance results
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  • Published on:
    Response letter to Nutritional rickets under 16 years: UK surveillance results
    • Suma Uday, Consultant, Paediatric Diabetes and Endocrinology Birmingham Women's and Children's Hospital and Institute of Metabolism and Systems Research, University of Birmingham
    • Other Contributors:
      • Wolfgang Högler, Professor and chair of Paediatrics

    Dear Editor

    Infant vitamin D supplementation prevents not just rickets but also hypocalcaemic seizures and cardiomyopathy (CMP). The BPSU survey (1) captures rickets incidence which, we feel compelled to highlight, represents only the tip of the iceberg of widespread vitamin D deficiency (VDD) in the population.

    In the UK, child surveillance checks are led by general practitioners (GPs). Most GPs do not receive postgraduate paediatric training and have inadequate undergraduate paediatric exposure, as acknowledged by the RCPCH president: “by any stretch of the imagination, GP training in the UK in paediatrics is woefully inadequate” (2). Recognising rickets requires paediatric experience as exemplified by recent cases of VDD induced CMP- one child’s death was preceded by multiple unfruitful visits to GPs and casualty (3). As the BPSU survey reached out only to paediatricians and not GPs, the extent of underreporting and under diagnosis is likely huge, limiting comparison with countries where paediatricians oversee primary care. The conclusion that rickets incidence in the UK is lower than expected downplays the extent of the underlying public health crisis, particularly when a significant number of cases were excluded [table 2 of (1)]. The true disease burden is unravelled when family members of affected children are investigated (3).

    Similar to previous studies, rickets incidence here is 90 to 166 fold higher in Asian and Black children compared to wh...

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    Conflict of Interest:
    None declared.