Osteomalacia - Preventing rickets

There are several steps you can take to help prevent rickets. These include ensuring that your child has a healthy, balanced diet and spends some time outside in the sun.

Diet

Make sure your child has a healthy, balanced diet that contains plenty of calcium and vitamin D.

Sources of vitamin D include:

• oily fish, such as salmon, sardines and mackerel
• eggs
• fortified fat spreads
• fortified breakfast cereals

Sources of calcium include:

• dairy products, such as milk, cheese and yoghurt
• green vegetables, such as broccoli and cabbage
• soya beans and tofu
• nuts
• fish where you eat the bones, such as sardines and pilchards  

If you have a restricted diet – for example if you are vegetarian or vegan – you may not be getting essential vitamins and minerals and may need to take vitamin supplements (see below).

Sunlight

Sunlight is a good source of vitamin D and is where most of our vitamin D comes from. The vitamin forms under the skin as a result of sun exposure.

In the UK, about 10-15 minutes of exposure on the hands and face when the sun is at its strongest (between 11am and 3pm) a few times a week during the spring and summer is enough for most people.

You won't get vitamin D from the sun if you wear sunscreen, but you should apply sunscreen with a sun protection factor (SPF) of at least 15 if you are outside for longer than 10-15 minutes. This will help protect your skin from sun damage.

Babies and young children have very sensitive skin that burns easily so they need to use stronger sunscreen and keep covered up when out in the sun.

In the UK, our skin isn't able to make vitamin D from sun during the winter (November to March) as the sunlight isn't strong enough. However, we can get vitamin D from our body's stores and from food sources during this period.

Read more about vitamin D and sunlight and staying safe in the sun.

Supplements

Most people can get all the vitamin D they need through their diet and by getting a little sun.

However, certain groups of people have an increased risk of developing a vitamin D deficiency and may need to take supplements to avoid getting rickets and osteomalacia (the adult form of rickets). These at-risk groups are discussed below.

Pregnant and breastfeeding women

The Department of Health recommends that all pregnant and breastfeeding women should take a daily supplement of 10 micrograms (µg) of vitamin D to reduce the risk of their child developing rickets.

Children

In the UK, the Department of Health recommends the use of vitamin drops for all babies and young children aged six months to five years (or from one month if their mother has not taken vitamin D supplements throughout pregnancy).

However, the Department of Health says infants who are fed infant formula will not need vitamin drops until they are receiving less than 500ml of infant formula a day, as these products contain added vitamin D.

It is important that children in high-risk groups take vitamin D supplements. These include children who do not get enough vitamin D from their diet and those with certain medical conditions such as kidney disease. Your GP can advise you about how much vitamin supplementation is needed.

Other at-risk groups

Other people who have an increased risk of developing a vitamin D deficiency and who may need to take supplements include:

• elderly people 
• people of Asian, African-Caribbean and Middle Eastern origin
• people who always cover up all their skin when they are outside
• people not exposed to much sun
• people who do not eat meat or oily fish