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General practitioners should be given financial support and/or incentives to implement a vitamin D supplementation programme similar to immunisation programmes.

A dedicated group of healthcare professionals should be made responsible and held accountable for delivering the policy.

At discharge from neonatal units, parents should be informed about supplementation and provided with the first bottle of vitamins.

At each health care contact such as antenatal visits, routine child health checks and immunisations adherence to supplementation should be monitored and documented.Universal supplementation of breast and formula fed babies will make the policy simpler and more effective.We recommend the following policy changes to improve adherence and prevent serious health complications: Adherence to supplementation is currently not monitored at child health surveillance visits.To confuse matters even more, the amount of vitamin D in the ‘Healthy Start’ vitamins is lower than that recommended by Public Health England. However, the scheme is overly complex thereby resulting in poor uptake.

Only low income families receive financial support through the ‘ Healthy Start’ scheme.

Parents are not given information on supplementation at discharge from hospitals after child birth.

Nearly 85% of parents are unaware of the need for supplementation.

Vitamin D in formula milk is not sufficient to protect infants from rickets. Moreover the infant doses recommended by the UK policy are not in line with the global consensus recommendations ( Munns et al 2016).

Whilst 85% of European countries supplement all infants irrespective of the mode of feeding Public Health England recommends supplementing breast fed babies and those babies who consume less than 500ml of formula milk.

The UK currently does not adopt any of the above factors: We identified the following factors to be significantly associated with increased adherence: universal supplementation of breast and formula fed infants, giving parents information at discharge from the hospital after child birth, providing financial support to families and monitoring adherence at child health surveillance visits. We have compared supplementation policies and implementation strategies across 29 European countries to determine factors influencing adherence ( Uday et al 2017). Adherence to supplementation in UK infants is the lowest in Europe at 5-20%. However, these are out-dated and poorly implemented (Uday and Hogler 2018). The UK currently has vitamin D supplementation policies for risk groups including infants, pregnant women and the dark skinned population.

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Amongst the UK residents, the Black, Asian and Minority Ethnic (BAME) groups are most at risk, as darker skin produces far less vitamin D than lighter skin. Unsurprisingly, nearly half of the UK population were vitamin D deficient in the National Diet and Nutritional Survey. However, the UK’s geographic location renders it UVB deficient for most of the year. Since there is very little vitamin D in diet, we rely on its synthesis in the skin triggered by exposure to ultra violet B (UVB) rays in sunlight. Low calcium can cause life threatening seizures and heart failure in babies. Hence vitamin D deficiency can result in rickets in children and osteomalacia (soft bones) in children and adults, but also hypocalcaemic complications.

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Given the increasing proportion of the BAME groups in the UK through birth and immigration ( Uday and Högler 2018) there is an urgent need to update the current policies and adopt evidence based implementation strategies.Īctive vitamin D helps absorb calcium from the gut which is required to maintain optimal bone health. However, these patients only represent the tip of the iceberg of widespread deficiency in the community and the true disease burden remains unidentified. In the UK, the number of children hospitalised due to complications of vitamin D deficiency is on the rise and almost exclusive to the BAME groups ( Uday et al 2018).