Vitamin D prescription: a review of British National Formulary for children recommendations, and a proposal

Andreas Kouklinos; Julian Lim; Benjamin Jacobs

doi:10.1530/boneabs.2.P173

Aims: To review changes in the advice regarding vitamin D deficiency in the UK and compare these with other national guidance.

Methods: All Vitamin D guidance in the Royal College of Paediatrics and Child Health 2003 guide (Medicines for Children) and in the eight editions since the British National Formulary for Children (BNFc) was first published in 2005 was reviewed.

Results: Dosage and indications of prevalence are shown in the Table 1.

Doses are higher than recommended by the UK Chief Medical Officers in 2005 and 2012. Emphasis in the remarks about prevalence has shifted from ‘deficiency is uncommon’ to ‘symptoms are uncommon’. Each of the eight editions has stated that children on treatment doses should have a blood test weekly (or twice weekly) to check calcium levels.

Table 1
	Maintenance	Treatement
Years	1 m+ (units)	6 m–12 y (units)	12–18 y (units)	1 m+ (units)	6 m–12 y (units)	12–18 y (units)	Indications of prevalence
2003 Medicines for Children	190	400	400	3000	6000	10 000
BNFc 2005	400–600 (neonatal 200–400)	400–600	400–600	3000	6000	10 000	‘Nutritional deficiency uncommon’, ‘Certain ethnic groups’
BNFc 2006	As above
BNFc 2007	400–600 (neonatal 200–400)	400–600	400–600	3000	6000	10 000	As above
BNFc 2008	400–600 (neonatal 200–400)	400–600	400–600	3000	6000	10 000	As above
BNFc 2009	400–600 (neonatal 400)	400–600	400–600	3000	6000	10 000	‘Symptomatic deficiency uncommon’, ‘Certain ethnic groups’
BNFc 2010	As above
BNFc 2011	400–600 (neonatal 400)	400–600	400–600	3000	6000	10 000	‘Asymptomatic deficiency common’, ‘Certain ethnic groups’
BNFc 2012	As above

Conclusions: The BNFc portrayal of D deficiency as an uncommon problem has gradually changed thorough the editions so that since 2011 the high prevalence of asymptomatic deficiency has been acknowledged. However the recommendation that children should have regular blood tests, which is not based on evidence, and is against the consensus of national experts, has remained through the editions. We propose a new clearer national dosage guide in line with the recommendations of the Chief Medical Officer and withdrawal of the recommendation to monitor serum calcium in well children with asymptomatic D deficiency.

Bone Abstracts

P173