Our management of child health in the UK is becoming a cause for serious alarm. Health outcomes for children born and living here have fallen behind those of many poorer countries. While rates of obesity among British children are rising, there is now a consistent problem with forms of malnutrition.
A report by Dame Sally Davies, the chief medical officer, published this week, highlighted the rise in rickets, a disease that many people would have assumed died out in Victorian times. A quarter of infants – more in some areas – are deficient in vitamin D and the report calls on ministers to consider making free vitamins available to all under-fives. The chief medical officer has requested that the National Institute of Health and Clinical Excellence (Nice) examine the economics of such a scheme.
The disgrace is that we already have a political response to the vitamin D problem. It was launched in 2006 and is called Healthy Start. This directed that mothers with the lowest incomes receive vouchers for fruit and vegetables as well as free vitamins – including vitamin D – for themselves and their infants.
But the scheme has been a failure: the numbers of infants with seizures or toddlers with rickets appear to have actually increased since 2006. Healthy Start vitamin uptake by mothers and babies, particularly in inner-city areas, has been extremely poor. In the majority of London boroughs less than 10% of eligible mothers have used the free vitamins.
Few hospitals and almost no pharmacies or primary care centres have had enough "Healthy Start" vitamins for pregnant mothers or newborn infants to permit continuous supplementation. Yet there are warehouses up and down the country full of stockpiles of unused vitamins. A lack of sensible supply chains, storage and a regular delivery system, together with a lack of staff training sabotaged Healthy Start.
Since the late 1990s hospital doctors have been finding infants with heart failure, fits caused by low calcium levels, delays in walking and rickets. These conditions are all caused by low levels of vitamin D. The vitamin is crucial to the body's use of calcium. Low levels of vitamin D cause muscle weakness. In growing toddlers calcium cannot be moved into bones, causing these to become soft, their cartilages swollen. A child with rickets is typically miserable, weak and late to walk. His or her legs are often bowed, the wrists swollen and tender. Problems develop with dental enamel too, leading to a higher rate of cavities in later life.
And of course an infant's level of vitamin D is usually low because the mother is also deficient. Mothers give vitamin D to the foetus in the womb and in their breast milk after birth. So such infants will have mothers with weakened, soft bones, gum disorders and muscle weakness too. Vitamin D deficient mothers can expect higher rates of bone and tooth problems in their middle age.
A case of rickets or hypocalcemic seizure in a child is not an isolated event. It should be of wider concern because the child with the problem is just the visible tip of the iceberg. For every infant that presents with these problems dozens more slightly milder cases are out there in the same communities, just not seen in clinics.
Government policies have not helped with other aspects of child nutrition. Healthy mothers have healthy babies. Yet this critical connection is not supported by our health services. We know, for instance, that we could prevent a greater proportion of congenital deformities of the spine and heart by fortifying our flour with folic acid. The evidence has been clear for many years and any risks have been established to be tiny. Yet British flour is not yet supplemented.
As the chief medical officer stated, our generation expected a future better than that of our parents. Nutritionally this is not the case for many of our children. They are less likely to have had the benefits of breastfeeding, more likely to have received unnecessary high-calorie milk feeds and considerably more likely to be malnourished.
We know vitamins work. These medications have a low cost and do not make much profit for manufacturers. There are many workers on the front line who would be keen to employ a simple universal system of supplements. This approach might further address some of the health disparities, such as those we know exist in inner cities. If we cannot rid one of the richest countries in the world of nutritional rickets in children, the problems with our health services are bigger than we thought.
