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Volume 939: debated on Friday 25 November 1977

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asked the Secretary of State for Social Services what has been the percentage increase in the number of cases of rickets in each of the last three five-year periods.

I regret that the information is not available. Rickets is not a notifiable disease.

asked the Secretary of State for Social Services (1) if he will conduct a departmental inquiry into the measures taken to deal with the preventable disease of rickets which led to outstanding success for the previous generation of children, and examine where present measures fall short of those proved successful in the past;(2) if he will take immediate and urgent action to ensure proper dietary prophylactic measures within the sections of the community at high risk of contracting rickets in children; and if he will make a statement.

Rickets in children is caused by a deficiency in vitamin D, a vitamin which is present naturally in foods that form part of a normal diet, or is produced by the action of sunlight on skin. The need for special dietary measures to prevent rickets in children has long been recognised. Preventive measures date from the 1940s, when margarine was fortified with vitamin D; the welfare foods scheme included vitamin D supplements, and national dried milk was fortified with vitamin D. Preventive measures today are provided by the continuing fortification of margarine; the provision of drops containing vitamin D which are available at health authority clinics either free or cheap for children up to the age of 5 years; and the fortification of most proprietary infant milk foods.The availability of vitamin D through normal diet, together with the fortification of certain foods and welfare food tablets for mothers and drops for children containing vitamin D, has eradicated rickets from most of the child population. However, I recognise that rickets continues to be a problem amongst a minority of children, particularly the children of some Asian immigrant families who have a diet low in vitamin D. My approach to this problem is twofold: to encourage, as part of the educative process, the spread of information about the dietary preventive measures; and to consider whether further steps are necessary to fortify foods with vitamin D. A useful educative booklet was published in 1976 under the auspices of the Panel on Child Nutrition of the Committee on Medical Aspects of Food Policy. This Booklet, "Topics of Our Time: 1: Vitamin D Deficiency and Osteomalacia", which discussed the prevention and cure of the vitamin D deficiency disease, rickets in children and osteomalacia adults, is one which I commend to all doctors, midwives, health visitors, teachers and others in close contact with those at risk, so that the preventive measures available and the need to make use of them are widely publicised.A Working Party of the Committee on Medical Aspects of Food Policy is at present considering the problems associated with the fortification of food, other than margarine, with vitamin D; and I expect to receive proposals before too long. Vitamin D can be toxic if too much is introduced into the body from the diet, and I am aware of the dangers of hypercalcaemia, which occurred in the 1950s when fortification of infant foods was increased.