Searchable abstracts of presentations at key conferences on calcified tissues
Bone Abstracts (2013) 2 P173 | DOI: 10.1530/boneabs.2.P173

ICCBH2013 Poster Presentations (1) (201 abstracts)

Vitamin D prescription: a review of British National Formulary for children recommendations, and a proposal

Andreas Kouklinos , Julian Lim & Benjamin Jacobs

Royal National Orthopaedic Hospital, Stanmore, UK.

Aims: To review changes in the advice regarding vitamin D deficiency in the UK and compare these with other national guidance.

Methods: All Vitamin D guidance in the Royal College of Paediatrics and Child Health 2003 guide (Medicines for Children) and in the eight editions since the British National Formulary for Children (BNFc) was first published in 2005 was reviewed.

Results: Dosage and indications of prevalence are shown in the Table 1.

Doses are higher than recommended by the UK Chief Medical Officers in 2005 and 2012. Emphasis in the remarks about prevalence has shifted from ‘deficiency is uncommon’ to ‘symptoms are uncommon’. Each of the eight editions has stated that children on treatment doses should have a blood test weekly (or twice weekly) to check calcium levels.

Table 1
Years1 m+ (units)6 m–12 y (units)12–18 y (units)1 m+ (units)6 m–12 y (units)12–18 y (units)Indications of prevalence
2003 Medicines for Children1904004003000600010 000
BNFc 2005400–600 (neonatal 200–400)400–600400–6003000600010 000‘Nutritional deficiency uncommon’, ‘Certain ethnic groups’
BNFc 2006As above
BNFc 2007400–600 (neonatal 200–400)400–600400–6003000600010 000As above
BNFc 2008400–600 (neonatal 200–400)400–600400–6003000600010 000As above
BNFc 2009400–600 (neonatal 400)400–600400–6003000600010 000‘Symptomatic deficiency uncommon’, ‘Certain ethnic groups’
BNFc 2010As above
BNFc 2011400–600 (neonatal 400)400–600400–6003000600010 000‘Asymptomatic deficiency common’, ‘Certain ethnic groups’
BNFc 2012As above

Conclusions: The BNFc portrayal of D deficiency as an uncommon problem has gradually changed thorough the editions so that since 2011 the high prevalence of asymptomatic deficiency has been acknowledged. However the recommendation that children should have regular blood tests, which is not based on evidence, and is against the consensus of national experts, has remained through the editions. We propose a new clearer national dosage guide in line with the recommendations of the Chief Medical Officer and withdrawal of the recommendation to monitor serum calcium in well children with asymptomatic D deficiency.

Volume 2

6th International Conference on Children's Bone Health

Rotterdam, The Netherlands
22 Jun 2013 - 25 Jun 2013


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