Early years providers must step in where health practitioners are failing to ensure parents are supplementing their children’s intake of vitamins, says Nigel Denby…
As I’ve highlighted in the past, the recurrence of rickets and vitamin D deficiency in the under-fives is one of the most frightening trends of the 21st century. And yet, the government has made free vitamin shots available to the families of all under-fives in the UK! So why is there a disparity?
I believe that nurses, doctors and health visitors are simply not managing to get the message across to parents that children need to take a daily supplement of vitamin D. Thousands of families are missing out on their free vitamin supplements either because they don’t know they are entitled to them, or that their children need them. Early years practitioners could be the most important group of professionals when it comes to filling this knowledge gap and saving our children from pain and suffering.
The debate about vitamin D has been ongoing for some time. Historically we thought everyone would produce enough vitamin D in their skin via sunlight and from eating foods that contain vitamin D. Now we know that’s just not the case. We’re seeing more cases of rickets and other signs of vitamin D deficiency in our youngest children. In some areas, it’s thought up to 75 per cent of children are vitamin D deficient (see ow.ly/Az5Hr). So what’s the answer? Should we add vitamin D to everyday foods like milk or cereals? Should we change our advice about protecting children’s skin from the sun? Some think we should do both of these, but perhaps there’s a simpler answer.
The government recognised the need for action when, in 2006, it launched the Healthy Start scheme. Healthy Start included the provision of free vitamin drops containing vitamin D for children from families receiving a benefits – yet now in 2014 only a tiny minority of eligible families take advantage of the scheme; why?
A number of studies have identified problems with the Healthy Start vitamin drops offer:
• The scheme is complicated and badly organised.
• Health professionals have poor awareness of the scheme and don’t talk to parents about it.
• Parents have poor awareness of the need for vitamins supplements for their children.
As well as seeing the problems, these studies have also recognised that a trick is being missed – early years practitioners probably have more contact and influence over parents than anyone else, so have a central role in stopping rickets and vitamin D deficiency in its tracks.
Historical data shows that in the early 1990s, half of young children were not getting enough of vitamins A or D. More recently, vitamin A intakes have improved and are being met by diet, but vitamin D intakes remain poor, and they are not likely to improve.
It’s a big challenge for any of us to get enough vitamin D because:
• Few foods naturally contain vitamin D (the best sources being oily fish and egg yolk).
• By law, vitamin D only has to be added to spreads, cow’s milk alternatives and infant formulas. Unlike other countries, we do not routinely add vitamin D to milk and other foods in the UK.
• Up to 90 per cent of vitamin D comes from exposure to sunlight and is produced in the skin. It’s estimated that we would need to be exposed to sunlight for 20–30 minutes a day to produce the required amount of vitamin D. When children fall short of their vitamin D requirements, they can become deficient and develop serious health problems, like hypocalcemic seizures and rickets – diseases that were considered long gone after the Victorian era. Not any more.
Since 2001 these health problems have been seen in greater numbers year on year (see ow.ly/Azl0y) culminating in 2007, when the Scientific Advisory Committee on Nutrition (SACN) and the governmental food and nutrition advisory body COMA made the following recommendations about vitamin D (ow.ly/Azlbc):
• All infants should receive vitamin supplements unless they consume more than 500ml of vitamin D-fortified formula daily.
• Breast-fed babies over six months need supplements, and those under six months should have supplements if the mothers vitamin status is not certain.
• Children over one year should have supplements unless their diet contains regular vitamin D sources and they are regularly exposed to sunlight.
• Children at risk of deficiency, those living in the north of the UK, those from Asian and Islamic families and poor eaters should take vitamin supplements until the age of five.
In short, COMA recommends almost all children should have vitamin D supplements.
Despite these very clear recommendations, in practice very few children are given supplements, and that even includes those from families who are eligible for free supplements via the Healthy Start scheme.
All families claiming benefits like Income Support or Child Tax Credits are eligible to collect vouchers and exchange these for healthy foods and children’s vitamin drops containing vitamins A, C and D under the Healthy Start scheme. Supplements for pregnant women are also available. However, from the outset Healthy Start was plagued with negativity and logistical problems – the distribution of vouchers and where these could be redeemed was clumsy and varied from one location to another.
A bumpy start to the scheme didn’t stop some families from taking advantage of the benefits, though. Of the half a million woman and children eligible for Healthy Start, around 80 per cent are registered and enjoy their free food. But when it comes to the children’s vitamin drops, a staggering 98 per cent of eligible children do not receive them. This is because:
• Two-thirds of parents don’t know about their children’s need for supplements.
• Less than a quarter of parents are told about the scheme.
• More than half of health professionals don’t discuss the need for children to have supplements with parents.
• A quarter of health professionals don’t promote supplements for children.
So, if parents aren’t getting the information they need from health professionals, what can nurseries and childcare professionals do?
• Ask parents at enrolment if their children are being given vitamin supplements.
• Advise parents that children under five should be given supplements, especially vitamin D supplements (providing 7.5ug vitamin D daily).
• Identify children at particular risk of vitamin D deficiency – those living in the north of England, Asian and Muslim children, children who do not eat well and are not regularly exposed to sunlight.
• Identify children who may be eligible for Healthy Start vitamin drops.
• Identify where Healthy Start vouchers can be exchanged for free vitamin drops in your area – you can access this information by entering your postcode at ow.ly/Azp0u
• Access and display leaflets and booklets about Healthy Start and vitamin supplements – these can be ordered for free by childcare providers at ow.ly/AzppJ
The experience of the Heart of Birmingham Primary Care Trust suggests it will. The ‘My little ray of sunshine’ scheme was trialled here to reduce the incidence of vitamin D deficiency disease. It simply involved displaying posters, distributing leaflets and promoting the benefits of vitamin D supplements. This resulted in a 21 per cent increase in supplement use and a 50 per cent reduction in recorded cases of rickets – that’s a real difference!
In the long term, of course we need more cohesive awareness-raising campaigns around children’s vitamin drops. We need to train health visitors, practice nurses and GPs to routinely talk to parents about using supplements. This all takes time, though – the reality is, if we wait for these initiatives and/or the government to make a decisions about adding vitamin D to more foods, it will be too late for a generation of children.
Readers of Teach Nursery see thousands of children and parents every day – by just asking a few simple questions and giving some free information out to parents, you could bridge the gap. You could save a child from having their bones broken and reset to repair the damage of rickets and vitamin D deficiency – and why wouldn’t you want to put a stop to that?
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