Some kids in Australia and New Zealand are not getting enough sun, and as a result, rickets and other vitamin D deficiency-related conditions are making a comeback, experts have revealed in the latest Medical Journal of Australia.
"Vitamin D deficiency and nutritional rickets are again emerging as major paediatric health issues in Australia and New Zealand," says Dr Craig Munns, paediatric endocrinologist at the Children's Hospital at Westmead, Sydney.
In his article, Dr Munns lists limb pain, fractures, rickets and hypocalcaemic (calcium deficiency) seizures among the health complications of vitamin D deficiency.
Children with dark skin and those who cover up for cultural reasons are most at risk, because they have reduced exposure to sunlight.
For infants, the major risk factor for vitamin D deficiency is its deficiency in their mothers. As such, all pregnant women, especially those veiled or dark skinned, should have their vitamin D evaluated during early pregnancy.
Prolonged breastfeeding is also a contributing factor. Breast milk can be a poor source of vitamin D, particularly if the mother has a deficiency herself.
"We endorse breastfeeding for all infants," Dr Munns says. However, he recommends that all at-risk breastfed infants receive supplements daily until 12 months of age.
Participation in outdoor activities should be encouraged for children and adolescents, rather than resorting to supplementation, Dr Munns says.
But while regular exposure to sunlight can prevent vitamin D deficiency, the safe exposure time for children is unknown.
"A balance needs to be struck between sufficient sun exposure... and minimising the risk of skin cancer," Dr Munns says.
For children who are dark-skinned, veiled, have reduced exposure to sunlight or have underlying medical conditions, it may be necessary to include daily vitamin D supplements in their diet.
Dr Munns also recommends checking the vitamin D status of any siblings of children diagnosed with vitamin D deficiency.
"The help of local community and cultural groups will be of major importance in ensuring the dissemination of these prevention strategies," he says.