When I was still training, my Mum said to me, “I hear rickets is coming back, do you see any kids with it”? As I looked around the kitchen for her copy of the Daily Mail, “No, not at all” I replied, rolling my eyes. She’s laughing now as rickets, or vitamin D deficiency, is one of the most common conditions I see as a Paediatric Orthopaedic Consultant. It is also the most easily treatable.

When discussing rickets it’s hard not to visualize the wartime skinny, malnourished child with massively bowlegs, prominent ribs and swollen tummy. This image is the extreme and I only see once or twice a year. In reality, many children with vitamin D deficiency are healthy looking and often spend a good amount of time outdoors. So who gets it and why am I seeing so much of it?

Typical symptoms :

-Pains in both legs, worse at night time, needing massaging/hot water bottles/calpol

-Generalised tiredness and muscle aches

-Recurrent colds/infections

Why do we need Vitamin D?

Vitamin D is responsible for regulating calcium and phosphate in the body. These minerals are essential for strong, healthy bones, muscles and teeth. There are thoughts now that it is very important in our immune system, depression, various cancers and reproductive health, but this is still under investigation.

Who is at risk?

– Reduced UV exposure – Children who do not go outside much, those who are completely covered up or wearing complete sunblock when outside

-Reduced Vitamin D intake – Vegans (Vit D found in fish, eggs, milk)

-Reduced Vitamin D absorption – long term liver/kidney/intestinal problems. Obesity (Vit D binds to fat making it not absorbable)

-Increased need for Vitamin D –pregnancy, breast feeding

How much Vitamin D do we need?

The intensity of cloud cover in the UK and our lack of sunny days, mean that our skin does not get enough UV light to make the vitamin D we need. It is estimated that during non-summer months, more than 1 in 3 of us in the UK are vitamin D deficient. This only falls to 1 in 4 in summer. We (excluding formula-fed babies) need 10mcg / 400iU per day of Vitamin D to be sufficient. Few foods provide enough dietary Vitamin D, therefore we need to rely on supplements. The multivitamin gummy bears/pills that are routinely sold rarely contain enough and are comparable to having a sweetie. I always recommend patients get Vitamin D sprays, which can be bought from pharmacies, as they contain a high enough concentration, taste nice and are very easy to use: “Put it by your toothbrush and that way you will remember to take it”.

When to seek medical help before self-prescribing vitamin D:

-Anyone with symptoms in just one leg. Unless otherwise proven, vitamin D deficiency gives pain on both sides.

-Worsening bowlegs.

-A child who has reliably been taking supplements but with no improvement/worsening symptoms.

Symptoms should start improving within a few weeks of taking the supplements. It’s important to remember that having vitamin D deficiency is not necessarily a result of having a poor diet or not going outside enough (although both contribute significantly), but is a fact of life in the UK. Life style changes are essential – weight loss, well balanced diet, not covering up completely in the sun and not being over zealous with sun block. Both my children get supplements, despite having no symptoms, and I would encourage everyone to do the same.

Miss Jo Dartnell

BSc (Pharmcology) MBBS MRCS FRCS (Tr & Orth)



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