G427(P) Managing bone health in children with neurological disability

Bone health is a topical issue, particularly relevant to patients with risk factors such as immobility, prolonged anticonvulsant therapy and poor nutrition. The PHA, NICE and RCPCH recommends consideration of Vitamin D supplementation in groups such as pre school children, pregnant women, and dark skinned people, particularly in winter months.1–3 However, clear guidance does not exist for children with severe neurological disability whose bone health is known to be poor.4 Methods Trust guidelines for Vitamin D surveillance in children with severe neurological disability are available from a previous audit in 2015/6 and the proforma created was used as a template for this study. 30 charts were selected at random from a severe learning difficulty school. The charts were compared to the proforma and results obtained. Results Of the cohort selected, 22 were male and 8 female with an age range of 5–22 years. The most common major diagnosis was autistic spectrum disorder. 8 patients were found to have at least one risk factor for Vitamin D deficiency, most commonly poor nutrition and long term anticonvulsant therapy. Of note, 2 of the patients had a previous fragility fracture. Only 2 out of these 8 patients were on Vitamin D prophylaxis, and the dosage was correct. Of those patients with risk factors, none had their vitamin D, PTH or bone profile checked in the past year. The patients with fragility fractures had not been referred to the Bone Clinic for further investigation as recommended. Conclusions This study highlights the importance of thinking about bone health in vulnerable groups. I have designed a poster, which is placed in all clinical areas for increased awareness and ease of prescribing, highlighting suitable formulations for different age groups and feeding method. A leaflet has been distributed to parents of children in the school to remind them of the need to consider vitamin D prophylaxis. References Vitamin D and you. Nov 2017. Public Health Agency. Guide for Vitamin D in childhood. RCPCH, October 2013. Vitamin D deficiency in children. NICE. November2016. Merglet S, et al. Epidemiology of low bone mineral density and fractures in children with severe cerebral palsy: a systematic review. Dev Med Child Neurol. 2009. Oct;51(10):773–8.