ࡱ> nqmy bjbj A{{3l l :::$^^^P,4^,A.<<<<###@@@@@@@$CF@:#Z#"|#|##@<< @p%p%p%#R<R<@p%#@p%p%S;x"?<QiYJ$>l@@0,A7?vG$FvG??vG:@##p%#####@@%R###,A####vG#########l :  13 April, 2010 Dr Judith Galtry Advisor Skin Cancer Control Cancer Society of New Zealand Inc National Office PO Box 12700 Wellington  HYPERLINK "mailto:judith.galtry@cancer.org.nz" judith.galtry@cancer.org.nz Dear Judith Response from PSNZ to Cancer Society Re position statement on Sun exposure in infants The Paediatric Society of New Zealand is unable to endorse this position statement as our membership considers that it poses an unacceptably high risk of leaving New Zealand infants and children at risk of Vitamin D insufficiency as well as deficiency. Recent evidence of long-term risks to bone health, type 1 diabetes, multiple sclerosis as well as possible short-term effects on risks of infection ADDIN EN.CITE  ADDIN EN.CITE.DATA  suggest we need to be cautious in making population level advice in this area. Our members see children with Vitamin D deficiency presenting with rickets and hypocalcaemic seizures as far north as the Waikato and Auckland. Our request is that this position statement be withdrawn until there is a full risk-benefit analysis for the NZ population. Indeed the 2008 food and nutrition guidelines from the NZ Ministry of Health are as follows: Infants and toddlers require appropriate exposure to sunlight to ensure adequate vitamin D status. From October to March (including the summer months), before 11 am and after 4 pm, expose an infants or toddlers face and arms to 520 minutes of direct sunlight per day. During winter and spring, infants and toddlers should spend time outside in the sun to prevent a reduction in vitamin D levels. From October to March (including the summer months), between 11 am and 4 pm, infants and toddlers should be provided sun protection, including full shade for the infants pram or play area, a broad-brimmed hat, sun protective clothing, and a broad spectrum sunscreen with a sun protection factor of at least 30. The Paediatric Society of New Zealand notes that you have based this position statement on the position statement published by the Cancer Council of Australia in 2005. Our concerns are as follows: The southern part of the North Island and the whole of the South Island are further from the equator than the major population centres in Australia. Only Tasmania is at a comparable latitude to the South Island. Infants, children and adults at these latitudes receive inadequate sun exposure in winter to provide healthy vitamin D levels. The statement New Zealands high ultraviolet radiation levels between the months of September and April mean that even when babies are outdoors for very short periods in the early morning and late afternoon with small amounts of skin exposed, they are likely to receive enough ultraviolet radiation exposure to maintain healthy vitamin D levels is too vague to provide adequate guidance to parents. What is a small amount of skin, and when is the early morning? Children in New Zealand have lower vitamin D levels than children in the UK or US. This has been attributed to the current policy on sun exposure in children in this country and the lack of Vitamin D fortification of milk and other nutrients. We know from the NZ nutrition survey that exposure to sun in Invercargill is very different to exposure to sun in Northland, as evidenced by a gradient of vitamin D levels, and that darker skinned children in the Waikato have lower vitamin D levels than European children (and the darker the skin the lower the levels). The current policy on sun exposure has been promulgated with concerns about the high incidence of skin cancer in later life in Europeans. However it has not been targeted at this group, but at all sectors of the population. The further perpetuation and promotion of this policy carries heightens the risk of poor vitamin D status in children with darker skins (especially Maori, Pacific, African and some Asian children). The Australian position statement bases the recommendations on the paper by Harrison et al. This was a study carried out in Townsville, where sun exposure is potentially much more harmful than in New Zealand. The findings of this study cannot be generalised to the New Zealand situation. It is our opinion that the issue of optimal vitamin D status in infants, children and adults in New Zealand needs a thorough appraisal of the evidence, before any change to the current recommendations provided by the Ministry of Health in the 0-2 Nutrition Guidelines (2008) can be made. A balance between sun protection and Vitamin status is needed, and this may require New Zealand to have a policy in NZ where breast fed infants are routinely recommended vitamin D supplementation and where milk in NZ is fortified with Vitamin D. Lastly, I note that the Australian position paper does not appear to have been reviewed or endorsed by any Paediatric organisation. You may wish to ask the Cancer Council of Australia whether this is because endorsement was declined or whether endorsement was never sought. Yours sincerely  Rosemary Marks (references available on request)     THE PAEDIATRIC SOCIETY OF NEW ZEALAND Secretariat: Email:Denise Tringham P O Box 22 234 Wellington 6441 Tel: (04) 938 4827 Fax: (04) 976 4827 psnz@paradise.net.nz  Health of our children: Wealth of our nation #~> ? ; < ɼɨ{naOO"jhLhHxB*CJUphhLh^UB*CJphhLhB*CJphhLh5B*CJphhLhHxB*CJph!hh0JB*CJ^Jph&jhhB*CJU^JphhhB*CJphhhB*CJ^Jph$hh0J5B*CJ^JphhHxhi&lhCJhh$G#?aq~ > ?  G & F$ d*$7$8$H$gd  7$8$H$gdHxgdgdHx H I V W ()FGٷudWWWMChLB*CJphh=B*CJphhLh=B*CJph!hLhMqypdx\egc N }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz? 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E.Jones, A. B.Prosser, C.Robinson, J. L.Vohra, S.Department of Pediatrics,University of Alberta, Edmonton, Canada. droth@jhsph.eduVitamin D receptor polymorphisms and the risk of acute lower respiratory tract infection in early childhoodJ Infect DisJ Infect Dis676-8019752008/02/13Bronchiolitis/*genetics/virologyCase-Control StudiesFemaleGenetic Predisposition to Disease/*geneticsHumansInfantInfant, NewbornMaleOdds RatioPneumonia/*geneticsPolymorphism, Genetic/*geneticsReceptors, Calcitriol/*genetics2008Mar 10022-1899 (Print) 0022-1899 (Linking)18266602http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1826660210.1086/527488engMcNally200918218218217McNally, J. D.Leis, K.Matheson, L. A.Karuananyake, C.Sankaran, K.Rosenberg, A. M.Department of Pediatrics, University of Saskatchewan, Saskatchewan, Canada.Vitamin D deficiency in young children with severe acute lower respiratory infectionPediatr PulmonolPediatr Pulmonol981-844102009/09/12Acute DiseaseAge DistributionBronchiolitis/epidemiology/*etiology/physiopathologyCase-Control StudiesChild, PreschoolFemaleFollow-Up StudiesHumansIncidenceInfantMaleOdds RatioPneumonia/epidemiology/*etiology/physiopathologyProbabilityReference ValuesRespiratory Tract Infections/epidemiology/etiologyRisk AssessmentSaskatchewanSeverity of Illness IndexSex DistributionVitamin D/*analogs & derivatives/bloodVitamin D Deficiency/*complications/diagnosis2009Oct1099-0496 (Electronic) 1099-0496 (Linking)19746437http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1974643710.1002/ppul.21089engHayes200319191917Hayes, C. E.Nashold, F. E.Spach, K. M.Pedersen, L. B.Department of Biochemistry, University of Wisconsin-Madison, 433 Babcock Drive, Madison, Wisconsin 53706, USA. hayes@biochem.wisc.eduThe immunological functions of the vitamin D endocrine systemCell Mol Biol (Noisy-le-grand)Cell Mol Biol (Noisy-le-grand)277-300492Autoimmune Diseases/*immunologyCommunicable Diseases/immunologyEndocrine System/*immunologyProtein Structure, TertiaryReceptors, Calcitriol/metabolismSupport, Non-U.S. Gov'tVitamin D/*immunology/metabolism2003Mar12887108http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12887108 DRoth200818418418417Roth, D. E.Jones, A. B.Prosser, C.Robinson, J. L.Vohra, S.Department of Pediatrics,University of Alberta, Edmonton, Canada. droth@jhsph.eduVitamin D receptor polymorphisms and the risk of acute lower respiratory tract infection in early childhoodJ Infect DisJ Infect Dis676-8019752008/02/13Bronchiolitis/*genetics/virologyCase-Control StudiesFemaleGenetic Predisposition to Disease/*geneticsHumansInfantInfant, NewbornMaleOdds RatioPneumonia/*geneticsPolymorphism, Genetic/*geneticsReceptors, Calcitriol/*genetics2008Mar 10022-1899 (Print) 0022-1899 (Linking)18266602http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1826660210.1086/527488engMcNally200918218218217McNally, J. D.Leis, K.Matheson, L. A.Karuananyake, C.Sankaran, K.Rosenberg, A. M.Department of Pediatrics, University of Saskatchewan, Saskatchewan, Canada.Vitamin D deficiency in young children with severe acute lower respiratory infectionPediatr PulmonolPediatr Pulmonol981-844102009/09/12Acute DiseaseAge DistributionBronchiolitis/epidemiology/*etiology/physiopathologyCase-Control StudiesChild, PreschoolFemaleFollow-Up StudiesHumansIncidenceInfantMaleOdds RatioPneumonia/epidemiology/*etiology/physiopathologyProbabilityReference ValuesRespiratory Tract Infections/epidemiology/etiologyRisk AssessmentSaskatchewanSeverity of Illness IndexSex DistributionVitamin D/*analogs & derivatives/bloodVitamin D Deficiency/*complications/diagnosis2009Oct1099-0496 (Electronic) 1099-0496 (Linking)19746437http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1974643710.1002/ppul.21089engHayes200319191917Hayes, C. E.Nashold, F. E.Spach, K. M.Pedersen, L. 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Submissions

The Paediatric Society believes all children and youth should, by right, attain optimal physical, mental and social health and wellbeing.  By working as a coordinated national network of health professionals the Society dedicates its efforts and resources to making official submissions to both Government and Non-Government organisations on issues that will impact on the health and wellbeing of children and young people.

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