Slapping on factor 15 or staying out of the sun altogether has become a way of life in the UK as health professionals warn that UBV rays can cause skin cancer. But people's increasing reluctance to expose their bodies to the sunshine has caused the re-emergence of the Victorian disease rickets.

The condition, characterised by bowed legs and delayed walking in young children, is caused by a lack of vitamin D – the main source of which is sunlight. Vital for strong bones, vitamin D forms under the skin in reaction to exposure to the sun.  Although present in many foodstuffs, it is not easy to get enough through diet.

Last year in Birmingham, 21 children were treated for vitamin D deficiency, even though rickets was virtually wiped out in the West during the 1940s.

Now, for the first time, Birmingham Community Healthcare NHS Trust (BCHC) is offering free vitamin D supplements to all pregnant women, new mothers and children under the age of four.

The initiative, which was rolled out across the city on 1 February, follows the success of the scheme in the Heart of Birmingham Teaching Primary Care Trust (HoBtPCT). Since was introduced in 2006, cases of rickets have dropped by more than half.

In 2005, there were 29 cases of rickets in children registered with HoB GPs, costing an average of £5,000 each to treat. But in the year to March 2010, that number had fallen to 12. The cost of supplying Vitamin D – which can be stored in the body – to a mother-to-be until her child is a year old is just £10.

"Rickets is not very common anyway, but it's totally avoidable and the HoBtPCT took the view that as it was preventable it should be prevented," explains Eleanor Mcgee, public health nutrition lead at BCHC. "When we did a re-audit, we found that cases had more than halved, so it looks like it's worth doing. As we're trying to work more across the city we thought we’d roll it out."

She says "modern lifestyles" have caused the resurgence of rickets.

"Vitamin D is present in lots of foods, but if you eat a low quality diet it can be difficult to get enough this way - the best source is oily fish and the British aren’t very good at eating that - so most of our vitamin D is formed in the skin from exposure to sunlight. Modern lifestyles, changes to children’s play habits, sensible use of sun screen, as well as a tendency to cover up in some cultures, means many of us aren’t getting enough rays."

This is despite the fact that only 15-20 minutes' exposure to the sun on the hands and face a few times a week during spring and summer is enough.

Eleanor says poorer families are more at risk from vitamin D deficiency, which in extreme cases can be fatal, because they are less likely to take sunshine holidays overseas. Darker skins need more sunshine than lighter ones.

 "Rickets is often considered a disease of the past – and that is exactly where we need to leave it. The vitamins are easy to get, easy to take and completely free, so we are urging all new and expectant mothers to speak to their midwife, GP or children's centre about getting their vitamins."

For more information visit Birmingham Community Healthcare NHS Trust.

Due for review October 2013