"Chief medical officer 'ashamed' as rickets makes a comeback," reports The Independent following the release of the annual chief medical officer's report. The report is a wide-ranging publication covering the complex issue of preventative medicine in children. Its findings are based on the concept that improving health in the first years of life can lead to sustained wellbeing in adulthood.
Most of the media has focused on just one of the report's recommendations. This is the guidance that the National Institute for Health and Care Excellence (NICE) examines whether it is cost effective for all children under the age of five to receive free drops or tablets containing vitamins A, C and D.
Under the current Healthy Start vitamin programme, free vitamins are usually only given to children and women whose families are on Income Support, income-based Jobseeker's Allowance, income-related Employment and Support Allowance, or Child Tax Credit.
The chief medical officer, Professor Dame Sally Davies, has made this recommendation because there is increasing evidence that the number of children with vitamin D deficiency is rising. As many as 40% of young children may have levels below the accepted optimal threshold.
Vitamin D deficiency causes the condition rickets, where developing bones soften, which can lead to bowed legs and curvature of the spine. It is easily prevented by exposure to sunlight several times a week without wearing sun cream, as well as a balanced diet that includes plenty of vitamin D and calcium.
However, in many families – often those on low incomes – the quality of children's diets is restricted, meaning they do not receive enough vitamins and nutrients. Children who spend long periods indoors are also at risk.
Professor Dame Sally Davies has asked NICE to update the evidence supporting the Healthy Child programme to consider if it would be cost effective for all children to receive drops or tablets containing vitamins A, C and D.
While likely to be expensive in the short term, a universal programme of vitamin supplementation could potentially save the NHS billions of pounds longer term.
Who produced the report and what is it about?
The chief medical officer and chief scientific adviser from the Department of Health has released an annual independent report, which this year is focused on how to improve the health and wellbeing of children and young people.
It is called Our Children Deserve Better: Prevention Pays (PDF, 9Mb) and includes 24 recommendations made after consultation with a broad range of experts, academics, clinicians and service providers, and listening to the opinions of children and young people.
What evidence has the report looked at?
Various reports were used to inform the chief medical officer's findings, including the NHS Atlas of Variation in Healthcare for Children and Young People 2013 and statistical analyses comparing the UK with other countries in Europe. These include statistics on mortality, obesity, sexual health, diet, physical activity levels and poverty.
One aspect of the report highlights the increasing number of children suffering from vitamin D deficiency. This gives an indication that only offering vitamins to disadvantaged children has not been enough to make a difference.
What are the report's other main recommendations?
Aside from the advice on vitamins, the report makes a number of other potentially very useful recommendations that have largely been ignored by the media.
- Improving collaboration between services to reduce inequalities in education, health and social wellbeing.
- Focusing on prevention and early intervention to reduce long-term issues such as obesity and mental health problems.
- Supporting several programmes that have shown improvements in public health, such as the Healthy Child programme and the Big Lottery Fund's A Better Start programme, which aims to improve the life chances of disadvantaged children in their first years.
- Continuing efforts to increase participation in physical activity.
- Deciding whether the Healthy Start vitamin programme should be extended to all children.
- Improving health services, for example by extending GP training to always include paediatrics and child health, and highlighting the important role of school nurses.
- Developing ways to improve the resilience and strength of young people to help reduce the risk of "exploratory behaviours".
- Increasing data collection to identify how many children and young people have mental health problems.
What will happen next?
Dame Davies is a well-respected figure and her opinions carry considerable weight. However, she is not an elected official, so there is no guarantee that any of her recommendations will be taken up.
It would be surprising, however, if NICE does not carry out the cost effectiveness analysis for the vitamin programme at the very least.
In the meantime, you can reduce your child's risk of vitamin D deficiency by giving them a balanced diet and allowing short periods of exposure to the sun without sun cream.
Read more about vitamin D in children.
Analysis by Bazian
Edited by NHS Website
Links to the headlines
The Independent, 24 October 2013
Daily Mail, 24 October 2013
BBC News, 24 October 2013
The Guardian, 24 October 2013