Endocrine Abstracts

A number of factors have been associated with the apparent increase in children with vitamin D deficiency (VDD) in developed countries: increased awareness, increased migration, children living with chronic illness or disabilities, effects of medication (e.g. glucocorticoids, anticonvulsants), use of sunscreen, changes in lifestyles and a rise in childhood obesity. The clinical features of VDD vary with age and degree of deficiency and importantly, calcium deficiency is now recognized as a key factor in symptomatic VDD. At presentation, children may be asymptomatic or, have musculoskeletal pain; and in severe cases hypocalcaemic seizures, rickets and life threatening cardiomyopathy may occur. Evaluation of children should include careful assessment of dietary intake, previous medical history, medication review (including use of complementary alternative medicines), growth and puberty, and systemic enquiry of symptoms suggestive of malabsorption. Biochemical investigations are merited in symptomatic cases and there are important rare diagnoses that should be considered when interpreting results. There are a variety of treatment regimens for VDD. Typically treatment is with cholecalciferol, administered in daily, weekly, monthly or 12 weekly doses. Oral doses are considered as effective as intramuscular injections in children with normal intestinal absorption. Potential side effects from treatment should be communicated to the family and are rare. Calcium supplements should be considered in those with inadequate dietary intake. The family should be made aware of the reasons for intervening, the differences between treatment versus supplement doses of vitamin D, and how to optimize diet and adverse lifestyle factors. Some licensed products are not palatable for children and achieving adherence can be challenging. Poor medicine adherence may be further aggravated by confusion regarding the doses required and inconsistent information given to families by health care professionals. I will review the contemporary multidisciplinary approach to the child presenting with vitamin D deficiency with illustrative clinical cases.