Background: There is currently considerable clinical and academic interest in vitamin D in children and young people. This partly relates to recognition of a resurgence of symptomatic vitamin D deficiency with reports of children presenting with rickets or hypocalcaemic symptoms. An additional development has been the recognition that vitamin D may have a physiological extraskeletal role beyond its traditional function as a key regulator of calcium and bone metabolism.
Presenting problem: There is recognition that many individuals have suboptimal vitamin D status often without symptoms. One response has been a large increase in requests for measurement of vitamin D (typically serum 25OH vitamin D (25OHD)). Lack of consensus and national guidance has contributed to variation in clinical practice in the UK in terms of both testing and vitamin D treatment in children and young people.
Clinical management: Guidelines for investigation and management of vitamin D deficiency in children and young people have been produced to guide clinicians in the UK. Consistent with other UK and European guidelines, the following definitions are used:
• Serum 25OHD <25nmol/l is deficient.
• Serum 25OHD of 25-50nmol/l may be inadequate in some people.
• Serum 25OHD >50nmol/l is sufficient for almost the whole population.
The guideline recommends:
• Measurement of serum 25OHD as the best way of estimating vitamin D status.
• Testing of serum 25OHD levels should be restricted to children and young people in whom there is a clear indication.
• Primary preventive measures should be undertaken in patients at high risk of deficiency. This would include advice about safe sunlight exposure, dietary sources of vitamin D and multivitamin supplementation.
• Treatment of vitamin D deficiency should be with oral preparations of vitamin D2 or D3 given daily for 812 weeks.
• Many children with vitamin D deficiency will benefit from advice about dietary calcium intake.
Discussion: By publishing these guidelines we aim to provide a useful resource that will benefit patients and families, support doctors and help to ensure that finite NHS resources are appropriately targeted. The full guideline can be accessed online at: www.nos.org.uk/professionals.
Disclosure: Dr Arundel and Dr Shaw have both provided consultancy to Consilient Health Ltd who manufacture vitamin D preparations.
27 Jun 2015 - 30 Jun 2015