The call by the Royal College of Paediatrics and Child Health (RCPCH) for widely available and low-cost vitamin D supplements, fortification of foods, greater knowledge amongst healthcare professionals (HCPs) and better public awareness to tackle the growing incidence of vitamin D deficiency amongst the UK population has been widely welcomed.

Recognition that vitamin D is essential for good bone health and optimum immune system function is increasing, but more awareness is needed about meeting requirements in the early years for its benefits to have the best chance for toddlers' long-term health. Most vitamin D is made in the skin when outside in sunlight during the summer months. Very few foods provide it - only oily fish is a good source. With our indoor lifestyles it is difficult to guarantee that young children will get enough from sunlight so supplements are required to ensure sufficiency. On average, children aged 18 months to three years only consume about a third of their daily requirement of vitamin D because very few are given the recommended supplement. Some foods are fortified with vitamin D including formula milks, margarine and some yogurts and breakfast cereals. However they contain very small amounts.

The Infant & Toddler Forum (ITF) hopes that this new RCPCH call to action can help add to the effort to achieve this. The re-emergence of rickets - thought to have disappeared at the beginning of the last century - is again a UK public health concern and this call to action could not have come sooner. In early 2012, the Chief Medical Officers' letter to GPs, health visitors and community nurses was to remind them to raise awareness of vitamin D's importance particularly with key at-risk groups. Professional guidance is vital in preventing deficiency but despite some targeted outreach, awareness around the importance of vitamin D supplements for under-fives and pregnant and breastfeeding women remains low.

As part of the combined effort by key stakeholders, in June 2012, the ITF produced Preventing Vitamin D Deficiency in Toddlers; an easy-to-follow resource, containing peer-reviewed guidance, outlining the key role for HCPs in preventing vitamin D deficiency. This provides clarity for HCPs and families on how vitamin D can be safely provided by sunlight, supplements and the very few foods it is present in.

Judy More, Paediatric Dietitian, member of the ITF and JFHC Board Member, said: "Unfortunately many parents and healthcare professionals think that a nutritious balanced diet will provide all the vitamins needed by young children. However vitamin D is the exception and even children who eat very well get very little vitamin D from their food. Without a daily vitamin D supplement they are at risk of vitamin D deficiency and along with that poor bone health and susceptibility to infections and long term diseases such as diabetes."

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