If there is an obvious significant deformity then the level should be checked but should not delay referral.
If the symptoms still persist then please re-refer. We would request that any level less than 50nmoll is treated as per this protocol and rechecked. We ask that you check the vitamin D level in any child with unusual limb or back pains without an obvious deformity. Initial treatment should last for six to eight weeks and be followed by maintenance of 400 IU daily.
Deficiency: 12 years - initial treatment 10,000 IU daily. The local recommendation is for children to have a serum vitamin D of more than 50nmoll-1. If the vitamin D level is found to be less than this then the treatment regime is to give high dose vitamin D for six to eight weeks followed by maintenance supplementation as shown below: The reference range for vitamin D has changed recently to be in line with international guidelines. Fortified breakfast cereal (330g = 40 IU). Less than 10% of vitamin D is acquired from diet, but foods high in vitamin D include: However, most people fail to apply sun cream effectively and only 5-30 minutes of direct sun exposure, twice a week, is required for vitamin D synthesis This is unfortunately blocked by glass or sun cream thicker than factor 8. Calcium imbalance: tetany, cardiomyopathy, seizures. Deformity: genu valgum, genu varum or growth retardation. Pain: especially lower limb long bone pain that might wake the child up from sleep at night. It is estimated that 16% of children in the UK will be deficient in vitamin D leading to myriad signs and symptoms. Vitamin D deficiency is very common in the UK due to diet, lifestyle, weather and our northern latitude. 
For children and adults aged 1-40 years the RDA is 600 IU (15µg). Deficiency of vitamin D is implicated in a great number of orthopaedic conditions, including SUFE, Perthes, osteomalacia and fragility fractures.įor babies up to one year of age the recommended daily allowance (RDA) is 400 IU (10µg).
The role of vitamin D is to facilitate calcium absorption from the gut and maintain calcium homeostasis. Vitamin D is a vital metabolically active compound that is either synthesised by the body using UVB light or absorbed via the digestive system from certain foods.
Vitamin D deficiency in children.pdf 408KB.
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