Highlights in this Issue

The return of rickets That vitamin D defi ciency has re-emerged as a signifi cant clinical and public health problem will come as little surprise to some readers from their own clinical experience. Over the last 10 years or so, Archives has carried a number of papers highlighting the problem in the UK and elsewhere, and Ahmed et al show how rapidly the problem has increased over the last decade in Glasgow. Since for many paediatricians rickets lingers only as a folk memory, it is timely and important that we are reminded of the various manifestations of the condition. Perhaps the most frustrating aspect is that the disease is, in principle, entirely preventable. In the accompanying editorial, Davies and Shaw examine the possibilities for prevention and remind us that vitamin D defi ciency is not just about the migration of populations used to high levels of powerful sunlight in their native environments. Over-zealous protection of children from ultraviolet skin damage, combined with indoor sedentary life styles, and obesity itself, are placing many other children at risk of vitamin D defi ciency in new ways. Yet in focusing on children we must not forget that one of the most important ways of improving vitamin D status, at least for infants, is to ensure that their mothers are not defi cient or borderline defi cient during pregnancy. The antenatal period can serve both as an opportunity for ensuring mothers at risk of personal defi ciency are appropriately treated, and for sensitising them to the need for ongoing supplementation to prevent defi ciency in their children – perhaps throughout childhood, though certainly in the preschool years. Never was the need for some joined-up thinking more acute. See pages 694 and 614