The return of rickets - this time among middle classes
IT IS a disease most often associated with Victorian slums, but it seems that rickets might be making a comeback in Scotland.
Doctors in Tayside have seen five cases of the bone disease in four months, prompting concerns of a resurgence of the condition among Scottish children.
Experts said the cluster - in middle-class families- could be "the tip of the iceberg" and called for the NHS to make sure women were given information on vitamin D supplements to avoid the problem.
NHS guidelines recommend supplements for pregnant women and babies breastfed for longer than six months. While breast milk remains the healthiest option for babies, it is low in vitamin D. Formula milk is fortified with the vitamin.
The latest cases of rickets, which causes weakened and deformed bones, were reported by Dr Stephen Greene and Dr Scott Williamson at Ninewells Hospital in Dundee.
Writing in the British Medical Journal, they said that none of the five children with rickets had received vitamin supplements to combat the problem.
Vitamin D, which is vital for bone health, is sometimes referred to as the "sunshine vitamin" because people get most of their intake from exposure to sunlight. Vitamin supplements are especially important for people from ethnic minorities because darker skin is more resistant to the sun's rays.
Dr Greene said all five cases they had seen involved ethnic-minority families. But unlike historic cases of rickets, there was no link to deprivation - he said all the children's parents were professionals.
Dr Greene said: "We have seen the odd case over the years, but when five suddenly appeared in just a few months, it raised the problem in our minds. What we are worried about is that it could be the beginning of an upturn in the incidence of rickets."
In the late 1800s, rickets affected two-thirds of infants in the UK. But the disease declined dramatically from the 1920s onwards with better living conditions and changes in diet.
Since then, there have been sporadic cases of rickets in the UK, including a cluster of six in Manchester ten years ago.
Dr Greene raised concerns that NHS recommendations on preventing the condition were not being followed. "We believe that the issue of [vitamin] supplementation needs to be high on the agenda," he said, adding: "It would be a good idea for all breast-fed babies to receive supplementation in Scotland because it is a northern country with less exposure to the sun."
Professor Annie Anderson, director of the Centre for Public Health Nutrition Research at Dundee University, expressed concern at the Tayside cluster.
"We get increasingly worried when you see more than just one isolated case.
"You really start to wonder if this is just the tip of the iceberg. People have not gone looking for these cases. They have been presented with them. One can assume that there is something greater going on out there."
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