No one told me children should take vitamin D pills – then my son got rickets
Four-year-old Toby Ault cried out in pain as his mother Kathryn gently lifted him up to tuck him into bed.
‘He said it was his legs and they were really hurting him again,’ says Kathryn, 27.
‘It was the third or fourth time in the space of a few weeks. At first I’d thought it might be growing pains, but by this stage I was starting to worry it might be something more serious,’ recalls the hairdresser, who lives in Lancing, West Sussex, with her partner Sam, 25, a surveyor.
“I just couldn”t believe it – Toby had always been so well cared for, but now he had a disease straight from the pages of Oliver Twist,” said Kathryn Ault of her son
Toby also wasn’t walking as well as his two older brothers Lewis, then six, and Jake, five, had done at the same age — ‘and his legs were a bowed shape,’ says Kathryn.
Itwas Kathryn’s 76-year-old grandmother Diana who, noticing this, raised the possibility that Toby might be suffering from rickets — a disease she remembered from her own childhood in the Thirties.
‘I thought it was highly unlikely,’ recalls Kathryn. ‘But I took Toby to my GP to be on the safe side.
‘Imaginemy horror when blood tests revealed my grandmother was right — Toby hadvery low vitamin D levels and was suffering from what the hospital children’s department described as early-onset rickets.
“Ijust couldn’t believe it — Toby had always been so well cared for, but now he had a disease straight from the pages of Oliver Twist.’
Rickets is a childhood disease that leads to weakened bones and deformities such as bowed legs and curvature of the spine (as the child grows, their increased body weight causes the weak bones to become mis-shapen and painful).
Left untreated, it can lead to complications such as painful cramps, muscle twitches, tingling in hands and feet, fits and breathing difficulties and even abnormal heart rhythm.
The most common cause of rickets is lackof vitamin D — known as the ‘sunshine vitamin’ because the body synthesises it when exposed to enough sunlight, as well as obtaining it from food.
The good news for Toby is his condition was in its early stages and the pain in his legs disappeared within a few months of starting on daily vitamin D supplements
Rickets was extremely common in the Victorian era because of a combination of lack of exposure to sunlight due to industrial pollution and poor diet, but mostly disappeared in Britain thanks to fortification (with added vitamins) of foods such as margarine in the Thirties and the introduction of cod liver oil supplements for pregnant women and under-fives in 1940 under the Welfare Food Scheme.
However, the disease is now making a comeback — a recent survey by Kellogg’s revealed 82 per cent of paediatric dietitians have seen a rise in cases in the past five years.
Cases of children under ten hospitalised with rickets leapt by 140 per cent between 2001 and 2009, increasing from 185 to 471.
And the reason for this alarming trend Declining consumption of oily fish and eggs — the richest dietary source of vitamin D.
A recent survey by the Department of Health showed dietary intake of vitamin D among children aged four to ten has declined from a daily average of 2.1 mcg in 1997 to 1.9 mcg last year.
Lack of exposure to the sun due to skin cancer fears and increasingly indoor lifestyles are also thought to be to blame.
A study published earlier this year by Professor Nicholas Clarke, consultant orthopaediac surgeon at Southampton General Hospital, found that more than 20 per cent of children checked for bone problems in his clinic had significant deficiencies.
‘We were also surprised to find that vitamin D deficiency cut across all social and ethnic groups,’ says Professor Clarke.
What many parents, like Kathryn, don’t realise is that children under five are at particular risk.
Toby”s bones now seem to be growing straight
Indeed since 1991, under Department of Health guidelines, children between the ages of six months to five are meant to be given a daily vitamin D supplement (7 mcg — most children’s multivitamins contain this amount).
As Sasha Watkins, of the British Dietetic Association, explains: ‘Although most of our vitamin D is made by the body after exposure to sunlight, diet becomes a more important source when children have limited access to the sun.’
However, fewer than one in 100 parents give their child a supplement with vitamin D, according to the Department of Health’s latest National Diet and Nutrition Survey.
‘GPs receive very little training in diet and nutrition and consequently many give very little or no advice to parents on how they can get enough calcium or vitamin D in children’s diets,’ says Sasha Watkins.
Kathryn says Toby’s problems began after he developed an allergy to cow’s milk at 18 months old.
He started wheezing when she gave him his first sips of cow’s milk and, over the next few weeks, the wheezing worsened. He also developed an itchy rash, so Kathryn him to her GP for a check-up.
‘I was worried he had asthma and wanted him tested, but kept getting fobbed off by my GP,’ she recalls.
Meanwhile Toby’s symptoms worsened.
‘I must have been back and forth to the surgery about five times in a year.
‘On the fifth visit I was really fed up and the GP suggested I cut out dairy products.
‘He gave me no advice about changing his diet, though, and didn’t offer to refer me for any tests.’
There was an immediate improvement in Toby’s symptoms and within two weeks both the wheezing and eczema had stopped.
Kathryn, mindful of the risks of lack of calcium, was assiduous in making sure Toby got enough.
‘I am quite well informed about diet as I’d formerly been a vegan, so I knew I needed to replace the calcium in Toby’s diet — that’s why I switched him to soya milk and yoghurts that were fortified with calcium so he didn’t miss out on any nutrients.’
But no one told her Toby also needed vitamin D so that the calcium in his soya milk could be absorbed — dairy foods naturally contain a trace of vitamin D.
‘Had I known about this I’d also have chosen a brand of soya milk fortified with vitamin D,’ she says.
Experts fear confusion over food allergies among both parents and GPs — and while Kathryn was meticulous about Toby’s calcium intake, other parents might not realise the risks.
As Dr Adam Fox, a consultant paediatric allergist at St Thomas’s Hospital in London, explains: ‘Unfortunately, some parents faced with a long wait to see an allergist or dietitian will go off and see nutritionists or complementary therapists in the High Street instead or just start cutting out food groups, which can be dangerous as children can become deficient in vitamins and minerals.’
The Scientific Advisory Committee on Nutrition is considering recommending a daily vitamin D intake not just for small children but everyone from age five to 65.
Other experts like Professor Clarke believe food fortification may be the answer.
He says: ‘Fortifying everyday foods like breakfast cereals, bread and milk is a good idea as there is evidence that adults as well as children may be vitamin D deficient.’
Earlier this month, Kellogg’s decided to fortify all its breakfast cereals which are marketed to UK children with vitamin D due to the alarming resurgence of rickets.
The good news for Toby is his condition was in its early stages and the pain in his legs disappeared within a few months of starting on daily vitamin D supplements.
His bones now seem to be growing straight. Kathryn also makes sure Toby eats lots of eggs and oily fish.
But Kathryn, who’s now eight months pregnant, is still furious that she inadvertently put her son’s health at risk.
‘Surely I should have been told about vitamin D supplements for toddlers — and why did my health visitor never mention it
‘Parents need much better access to dieticians and there needs to be given more emphasis put on vitamin D generally. Most people think rickets is to do with malnourishment. But it can affect even well cared-for children like Toby.
‘There are probably lots of middle-class mums out there who look out for allergies, change their children’s diets and slap on the suncream — thinking they are doing the right things, but putting their children at risk of rickets.’