An NHS scheme to give life-saving vitamin D to under fives is reaching only a tiny minority of children in the UK. A radical overhaul is needed if the epidemic of chronic disease linked to vitamin D is to be halted, an expert said last night.

Diabetes, asthma, multiple sclerosis and life-threatening heart disease in babies are all linked to low levels of vitamin D in early life. These diseases have become increasingly common over the last 40 years as the vitamin D level of the UK population has declined.

Vitamin D deficiency has increased as a result of changes in living habits and fashions that shade us from the sun, our major source of the vitamin. Young children no longer wear shorts, girls wear tights and leggings, people stay indoors more because of television and computers, while use of sun creams and cosmetics block the sun's UV rays that make vitamin D in skin. Official policy is that pregnant women should take a vitamin D supplement but few are actually advised by doctors and midwives to do so.

The government plan to provide vitamin D supplements for babies is not working because high street chemists have refused to stock the government's Healthy Start product on account of its short shelf life. As a result the vitamins are only distributed through a few community pharmacies attached to mother and baby clinics. In 2009/2010 the English government paid for Healthy Start vitamin supplement going to only about 5,000 children under five out of some 2 million children who could benefit and to only some 1500 women out of about half a million pregnant women who could benefit. In Scotland in 2009/10 only 76 children aged six months to 4 years and only 120 mothers received Healthy Start vitamins paid for by the government.

A few Primary Care Trusts in Birmingham, Bristol and Lancashire which have large ethnic minorities, distributed additional Healthy Start vitamins to children because people with dark skin are particularly vulnerable to vitamin D deficiency and consequent illness. Several Scottish Health Boards are planning, or have begun, to sell the children's vitamins to all mothers who want them, most progress has been made in the Western Isles and Fife.

Oliver Gillie, of the Health Research Forum, said that the Healthy Start scheme was badly implemented, does not work properly, and ignores the needs of mothers and children who are not on benefits and so do not qualify for free Healthy Start vitamins. In a lecture last night to the health charity, Caroline Walker Trust, Gillie said that the scheme is a farce and unless it is extended will never reach more than a small minority of women and children.

Gillie was also critical of NHS advice that babies do not need a vitamin D supplement until they are six months old. Mothers in the UK generally have little vitamin D in their milk because we get so little sun in this country and the public has been wrongly advised to avoid the sun. So breast fed babies are often short of the vitamin while bottle-fed babies obtain a vitamin D supplement in their formula.

Shortage of vitamin D puts breast fed babies at risk of heart attacks or heart failure especially if they are born in winter when vitamin D levels of the mother are lowest. Dr Michael Burch of Great Ormond Street Hospital investigated 16 cases of babies with heart attacks and heart failure. Two were scheduled for heart transplants but recovered when given vitamin D as did 11 others, three died.

Dr Burch said: "Life threatening heart failure occurring in babies in 21st century London, just from failure to be given a vitamin, is a shocking fact."

Advice that babies do not need extra vitamin D in the first six months of their lives is based on the assumption that the mother passes it on. But Gillie said: "When mothers have low vitamin D the baby too is low in the vitamin at birth. Also, the half-life of vitamin D is six to 10 weeks and so by six months the baby's vitamin D store, unless it is replenished, may be reduced to less than a quarter of what it was at birth.

"I know of no other country in the world giving advice not to start vitamin D supplements before six months. The practice has no scientific foundation that I am aware of. In other countries, such as the United States, Canada and many European countries, the need for vitamin D supplements for babies is well recognised and babies are started on vitamin D in the first week of life."

Vitamin D is vital not only for prevention of diseases in childhood it is also linked to a lower risk of heart and blood vessel disease, arthritis, Crohn's disease (a common bowel illness) and cancer, particularly bowel and breast cancer. It also boosts protection against some common infections such as flu.

Other points in Oliver Gillie's lecture

- Give doctors more information and make suitable ethical products available for them to prescribe for patients with vitamin D deficiency disease.

- Advise all cardiology, diabetes, cancer and arthritis patients, among others, to take vitamin D with the aim of optimising their blood levels. To do this successfully doctors must be prepared to arrange blood tests so that both they and their patients know when the optimum blood level is reached.

- Create new guidelines for the UK recommending doses of 2000-4000 IUs of vitamin D per day for all adults to be taken at least during the eight non-summer months and all year round by those who do not sunbathe. Doses of 400-1000 IUs or more need to be recommended for children under 10.

- Tell the food industry to wake up and make added-value, vitamin-D-fortified, products ��" and profits. Promote SunSafe advice on benefits of sunshine.

- Encourage summer fashions for men and women and school uniforms that allow the baring of arms, shoulders and legs. For example, short sleeves should be encouraged throughout the summer term.

- Make sure children's school playgrounds provide sunshine as well as shade. Encourage outdoor sports and games for all ages.

- Preserve parks, playing fields and all outdoor leisure spaces from development. Provide sheltered sunny nooks in parks and in planning new developments.

- Ensure that whenever possible new-build apartments have balconies both front and back to provide sun and shade throughout the day.

Oliver Gillie was giving the annual Caroline Walker Trust lecture in London.

The Trust was set up in memory of the nutritionist and campaigner Caroline Walker, who died in 1988. The Trust's mission is the improvement of public health by means of good food ��" a cause which Caroline made important to everybody in this country. The Trust, which relies on charitable donations, exists to further her work through research and publications.

Oliver Gillie's Health Research Forum offers advice about exposure to the sun, saying that the middle of the day is a good time to sunbathe. "Remove as many clothes as you can. Start by sunbathing for 2-3 minutes each side. Gradually increase from day to day to a maximum of half an hour per side", and "do not use sun screen while aiming to boost vitamin D".

Healthy Start

The original intention of the Healthy Start vitamins policy was that the vitamins would be sold by high street pharmacies, but the shelf life of the vitamins for babies is so short they refused to stock it. So only a few Community Pharmacies stock the vitamins. Pharmacies do stock a separate Healthy Start vitamin product for mothers but very few women buy them because the government has failed to promote them adequately.

Milk has been fortified with vitamin D in the US and Canada since the 1930s and is available as an option in some European countries. Finland introduced mandatory fortification of milk and margarine in 2003, and recently the Republic of Ireland fortified semi-skimmed milk. However scientists and doctors advising British governments have been unable to agree a strategy for fortification.

Health Research Forum