{"id":24301,"date":"2025-06-16T20:19:12","date_gmt":"2025-06-16T19:19:12","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=24301"},"modified":"2025-08-19T15:05:17","modified_gmt":"2025-08-19T14:05:17","slug":"vitamin-d-deficiency-paediatrics","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/vitamin-d-deficiency-paediatrics\/","title":{"rendered":"Vitamin D Deficiency (Paediatrics)"},"content":{"rendered":"\n<p><strong>Who should get vitamin D supplementation?<\/strong><\/p>\n\n\n\n<p>The UK Scientific Advisory Committee on Nutrition recommends that <strong>everybody in the UK population <\/strong>should take a daily 400 unit (=10\u00b5g) vitamin D supplement, throughout the year.<\/p>\n\n\n\n<p><strong>Who should I check a vitamin D level on?<\/strong><\/p>\n\n\n\n<p>Patients with symptoms and signs of vitamin D deficiency.<\/p>\n\n\n\n<p><strong>Symptoms and signs of vitamin D deficiency:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Bone pain<\/li>\n\n\n\n<li>\u2018Growing pains\u2019<\/li>\n\n\n\n<li>Muscle weakness<\/li>\n\n\n\n<li>Gross motor delay<\/li>\n\n\n\n<li>Poor growth<\/li>\n\n\n\n<li>Dental caries<\/li>\n\n\n\n<li>Symptoms of hypocalcaemia (seizures, tetany)<\/li>\n\n\n\n<li>Clinical signs of rickets (thickened wrists, genu varum, genu valgum, rachitic rosary, pectus carinatum, kyphoscoliosis, craniotabes, frontal bossing) or radiological features of rickets<\/li>\n\n\n\n<li>Bone biochemistry abnormalities found on incidental testing (e.g. incidental raised ALP)<\/li>\n<\/ul>\n\n\n\n<p><strong>Investigations \/ clinical assessment:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>25-OH vitamin D<\/li>\n\n\n\n<li>Calcium, phosphate, U&amp;Es and creatinine, LFTs, ferritin, FBC and PTH (iron deficiency anaemia and vitamin D deficiency often co-exist)<\/li>\n\n\n\n<li>Left wrist x-ray (specify ?rickets)<\/li>\n\n\n\n<li>Plot height&amp; weight(and head circumference if &lt;2 years)<\/li>\n<\/ul>\n\n\n\n<p><strong>Biochemical presentation of Vitamin D deficiency:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>25-OH vitamin D &#8211; low<\/li>\n\n\n\n<li>Calcium &#8211; normal or low<\/li>\n\n\n\n<li>Phosphate \u2013 normal or low<\/li>\n\n\n\n<li>Alkaline phosphatase (ALP) \u2013 normal or high<\/li>\n\n\n\n<li>PTH \u2013 normal or high<\/li>\n<\/ul>\n\n\n\n<p>Refer to current NHS Lothian Vitamin D Deficiency in Children for more details <a href=\"http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/ChildrensServices\/PoliciesGuidelines\/ClinicalPolicies\/Documents\/Vit%20D%20Guideline.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">NHSL Guideline Template<\/a><\/p>\n\n\n\n<p><strong>D.R.M &amp; C.H. 04-07-25<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Who to refer:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Normal vitamin D level and abnormal biochemistry and\/or presence of rickets \u2013 discuss with Paediatric Endocrinology \u2013 see contact details section on <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatric-endocrinology-diabetes\/\" target=\"_blank\" rel=\"noreferrer noopener\">Endocrinology &amp; Diabetes (Paediatrics) \u2013 RefHelp<\/a><\/li>\n\n\n\n<li>If any deviation from the expected course during treatment of vitamin D deficiency, for example if unexpected abnormal results after treatment.<\/li>\n<\/ul>\n\n\n\n<p><strong>Who not to refer:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Most children and young people with straight forward Vitamin D deficiency (i.e no suggestion of rickets or unexpected biochemistry results) can be managed safely in primary care (see <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vit-D-Paeds-flowchart.png\" target=\"_blank\" rel=\"noreferrer noopener\">Management flowchart <\/a>under Primary Care Management tab)<\/li>\n\n\n\n<li>Elevated urea or creatinine \u2013 discuss with Paediatric Nephrology<\/li>\n\n\n\n<li>Elevated liver enzymes or suspected GI malabsorption \u2013 discuss with Paediatric Gastroenterology \u2013 see contact details section on <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatricgastrointestinal\/\" target=\"_blank\" rel=\"noreferrer noopener\">Gastrointestinal \u2013 RefHelp<\/a><\/li>\n<\/ul>\n\n\n\n<p><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Management of Vitamin D deficiency: this is done in primary or secondary care<\/strong><\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"854\" height=\"1024\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vit-D-Paeds-flowchart-854x1024.png\" alt=\"Vit D Paeds flowchart\" class=\"wp-image-24303\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vit-D-Paeds-flowchart-854x1024.png 854w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vit-D-Paeds-flowchart-250x300.png 250w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vit-D-Paeds-flowchart-768x921.png 768w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vit-D-Paeds-flowchart-1280x1536.png 1280w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vit-D-Paeds-flowchart-950x1140.png 950w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vit-D-Paeds-flowchart.png 1342w\" sizes=\"auto, (max-width: 854px) 100vw, 854px\" \/><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><\/figure>\n<\/div>\n\n\n<p><strong>Prescription of Vitamin D supplements (Table 1):<\/strong><\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"672\" height=\"451\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Prescription-table-1.png\" alt=\"Prescription table 1\" class=\"wp-image-24317\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Prescription-table-1.png 672w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Prescription-table-1-300x201.png 300w\" sizes=\"auto, (max-width: 672px) 100vw, 672px\" \/><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><\/figure>\n<\/div>\n\n\n<p><strong>Cholecalciferol treatment (Table 2):<\/strong><\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"721\" height=\"258\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Cholecalciferol-table-2.png\" alt=\"Cholecalciferol table 2\" class=\"wp-image-24318\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Cholecalciferol-table-2.png 721w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Cholecalciferol-table-2-300x107.png 300w\" sizes=\"auto, (max-width: 721px) 100vw, 721px\" \/><figcaption><span class=\"media-credit\"> <\/span><\/figcaption><\/figure>\n<\/div>\n\n\n<p><strong>Calcium treatment (Table 3):<\/strong><\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"690\" height=\"378\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Calcium-table-3.png\" alt=\"Calcium table 3\" class=\"wp-image-24319\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Calcium-table-3.png 690w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Calcium-table-3-300x164.png 300w\" sizes=\"auto, (max-width: 690px) 100vw, 690px\" \/><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><\/figure>\n<\/div>\n\n\n<p><strong>Monitoring (for patients with proven vitamin D deficiency commenced on cholecalciferol AND calcium):<\/strong><\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"811\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vit-D-Paeds-flowchart-2-1024x811.png\" alt=\"Vit D Paeds flowchart 2\" class=\"wp-image-24334\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vit-D-Paeds-flowchart-2-1024x811.png 1024w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vit-D-Paeds-flowchart-2-300x238.png 300w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vit-D-Paeds-flowchart-2-768x608.png 768w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vit-D-Paeds-flowchart-2.png 1332w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><\/figure>\n<\/div>\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong> <\/strong><a href=\"http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/ChildrensServices\/PoliciesGuidelines\/ClinicalPolicies\/Documents\/Vit%20D%20Guideline.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>NHSL Guideline Template<\/strong><\/a><strong> <\/strong>(Vitamin D Deficiency in Children and Young People NHS Lothian guideline)<\/p>\n\n\n\n<p><a href=\"https:\/\/www.gov.uk\/government\/publications\/sacn-vitamin-d-and-health-report#:~:text=In%20a%20change%20to%20previous,aged%204%20years%20and%20older\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>SACN vitamin D and health report &#8211; GOV.UK<\/strong><\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fpublichealthscotland.scot%2Fpublications%2Fvitamin-d-and-you&amp;data=05%7C02%7CHeather.Levy%40nhs.scot%7C07847036cd024080641408ddb4be7330%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638865452239013578%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=Je%2BAwqcZkSUiv%2FV2ci9odN4MUuB0REEh212LmZwwktc%3D&amp;reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\">Vitamin D and you &#8211; Publications &#8211; Public Health Scotland<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.bda.uk.com\/resource\/vitamin-d.html\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.bda.uk.com\/resource\/vitamin-d.html<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Who should get vitamin D supplementation? The UK Scientific Advisory Committee on Nutrition recommends that everybody in the UK population should take a daily 400 unit (=10&micro;g) vitamin D supplement, throughout the year. Who should I check a vitamin D level on? Patients with symptoms and signs of vitamin D deficiency. Symptoms and signs of<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":18302,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[1254],"class_list":["post-24301","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-vitamin-d-deficiency-paediatrics"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/https-apps-nhslothian-scot-refhelp-medical-paediatrics\/https-apps-nhslothian-scot-refhelp-vitamin-d-deficiency-paediatrics\/\" rel=\"tag\">Vitamin D Deficiency Paediatrics<\/a>","rttpg_excerpt":"Who should get vitamin D supplementation? The UK Scientific Advisory Committee on Nutrition recommends that everybody in the UK population should take a daily 400 unit (=10&micro;g) vitamin D supplement, throughout the year. Who should I check a vitamin D level on? Patients with symptoms and signs of vitamin D deficiency. Symptoms and signs of","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/24301","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=24301"}],"version-history":[{"count":16,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/24301\/revisions"}],"predecessor-version":[{"id":25204,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/24301\/revisions\/25204"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/18302"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=24301"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=24301"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}