Should every child in the UK be given vitamin D supplements?

Written by: Dr Taher Mahmud
Published:
Edited by: Nicholas Howley

That’s the latest advice from the Scientific Advisory Committee on Nutrition – but is vitamin D deficiency really that widespread? How do I know if my child is vitamin D deficient? We asked expert rheumatologist Dr Taher Mahmud, who has a specialist interest in bone health, and gastroenterologist Dr Frank Lyons.

How common is vitamin D deficiency in the UK?

As you can imagine, it varies depending on the time of year. According to Public Health England, approximately 30-40% of the UK population is vitamin D deficient in the winter months. Even towards the end of summer, 13% of adolescents remain deficient (compared to 8% of adults).

It’s hard to properly define vitamin D deficiency because it is not exactly a clinical diagnosis. By “deficient” we mean levels that are low enough to cause increased risk of poor musculoskeletal health. So on the whole it’s a significant public health issue.

What are the risks of being vitamin D deficient?

The main risk to children is the impact on bone health. Vitamin D deficiency impairs the absorption of calcium and phosphorus and can thus lead to poor mineralisation of the bones. Adolescence is a critical period for bone health, so without sufficient vitamin D, your child’s bone density can be affected during this time, and they may never reach their full potential of peak bone mass.

Aside from this, vitamin D deficiency can cause muscle weakness at any age.

Finally, there is evidence that vitamin D deficiency in adults is related to osteoporosis, heart disease, multiple sclerosis and mental health issues – but this has yet to be demonstrated in children.

Is my child at risk?

There are a lot of factors that can affect your child’s chances of being vitamin D deficient. Children are at a higher risk of vitamin D deficiency if:

Diet is a factor, but we only tend to get 10% of our vitamin D through our diet. So your child is slightly more at risk if they have a vegetarian or vegan diet, or an exclusion-based diet (e.g. those with a dairy allergy).

The most important factor is the amount of sunlight your child gets.

What about all the advice on keeping children protected from the sun?

The time it takes for us to make sufficient vitamin D from the sun varies from person to person. It can be affected by environmental as well as personal factors. On the whole, however, it doesn’t take long – crucially, less time than the amount of time needed for skin to redden and burn.

Therefore it should be possible to enjoy the sun safely, getting the vitamin D levels required without causing skin damage.

So why are vitamin D supplements recommended?

It’s mainly a precautionary measure, but it reflects the fact that in the UK, while in theory we can get our vitamin D needs from sunlight exposure, in practice it’s difficult. Vitamin D can only be made in the summertime, between April-May and September-October, depending on where you are in the UK. Vitamin D absorption can also be hampered by cloud and also by air pollution.

The Scientific Advisory Committee on Nutrition recommends taking 10 micrograms of vitamin D per day. You can buy vitamin D tablets in pharmacies – it’s not generally necessary to get stronger tablets on prescription, unless in some instances where you child is showing symptoms of deficiency. Finally, it’s best to buy tablets containing only vitamin D, because multivitamin tablets tends to contain far too low a dose of vitamin D to be effective.

By Dr Taher Mahmud
Rheumatology

Dr Taher Mahmud is a distinguished consultant rheumatologist based in central London and Tunbridge Wells. He is renowned for his expertise in osteoporosis, osteopenia, osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and inflammatory arthritis.

Dr Mahmud qualified in medicine from King's College London before undertaking training at various esteemed institutions including St Thomas', and Pembury Hospitals. He also completed an esteemed research fellowship at King’s College Hospital, also gaining an MD and a Master’s in biochemistry. He further honed his skills in rheumatology through specialist training at King's College, the Lupus Unit at St Thomas', and Guy's Hospital Rheumatology Units. Dr Mahmud has served as a consultant rheumatologist since 2000, and was awarded fellowship of the Royal College of Physicians in 2014. Boasting more than 30 years of experience, Dr Mahmud has held various prominent roles throughout his career, including as cofounder and clinical lead for osteoporosis at the London Osteoporosis Clinic, and has also received a Clinical Excellence Award in recognition of his excellence and dedication to his practice. He currently sees private patients at HCA UK, The Shard and 25 Harley Street.

Additional to his clinical practice, Dr Mahmud has held a number of esteemed positions in public associations throughout his career, with a particular focus on improving patient experience and outcomes, including as a member of the MTW Patient Experience Committee and as an organiser and chair of conferences on patient experience at the Royal Society of Medicine. In recognition of his commitment to drive improvement in this area, he was awarded an NHS Innovations award for patient feedback. He has also been actively involved in medical education throughout his career, having lectured and trained a wide range of medical students and fellow practitioners.

With a wealth of expertise and experience, Dr Mahmud continues to make significant contributions to the field of rheumatology. He has appeared in numerous peer-reviewed publications and has authored his own book on the subject of patient care and feedback. Dr Mahmud is passionate about raising awareness of the prevention of osteoporosis fractures and maintaining healthy bones. He has appeared on several podcasts as an expert speaker on bone health and osteoporosis and the menopause. Dr Mahmud is also a member of various professional organisations, including the American College of Rheumatology, British Medical Association, British Society of Rheumatology, General Medical Council and the Royal Society of Medicine.

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