AimsFemale genital mutilation (FGM) is the name given to procedures that involve partial or total removal or other injury to the female genitalia for nonmedical reasons. This study describes the presentation, incidence and clinical management of children with FGM in the UK and Republic of Ireland (ROI).MethodsCases of FGM were reported using the established national British Paediatric Surveillance Unit (BPSU) reporting system. The data period is from November 2015-November 2017 with a 12 month follow up.ResultsThese interim results are from 120 cases reported (November 2015-September 2017). 61 (51%) had confirmed FGM, 18 cases were reported in error or were duplicates, 36 questionnaires were incomplete [5 did not meet case definition]. 48% (n=29) of the 61 confirmed cases were classified as type 2.In over 72% of the 61 cases, the parent disclosed child’s history of FGM. At the time of diagnosis, 80% of children (n=49) were four years or older (11 cases not recorded). Most children were diagnosed between 5 years and 10 years 11 months (n=27) or 11 years and 15 years 11 months (n=20) with 3 cases diagnosed between 0 and 4 years 11 months. In 51% of cases FGM was said to have been performed when the child was between 0 and 3 years (n=31). 93% (n=57) were performed before arrival to the UK.13% (n=8) of children had medical symptoms attributed to FGM, with 7% (n=4) of children identified to have mental health symptoms relating to FGM. No children presented with a history of labiaplasty or genital piercing.ConclusionNumbers reported were lower than expected for UK estimated prevalence with fewer physical and mental health symptoms than anticipated. Further information is needed to determine illegality under UK law. These findings should be used to educate health, social care, police and education on prevention programmes to influence national policies.FundingDepartment of Health England.

AimsRickets is a disease of growing children with serious short and long-term complications. Although the prevalence of rickets has been reported widely to be increasing the actual national incidence of nutritional rickets (NR) in the United Kingdom (UK) is unknown. This study aims to describe the incidence, presentation, and clinical management of children with NR in the UK and ROI.MethodsData was collected prospectively monthly between March 2015-March 2017 from 3500 paediatricians using British Paediatric Surveillance Unit reporting methodology.Results130 cases met the case definition with an overall annual incidence of 5.04 cases per million children under 16 years.London, East Midlands, West Midlands and Scotland had estimated incidences above the national incidence. Boys (91/130; 70%) were significantly more affected than girls (39/130; 30%) and the majority were of Black (44.6%) and South Asian(36.2%) ethnicity with a median age of 18 months. The commonest clinical presentations were bowed legs, swollen wrists and radiological rickets. Comorbidities included fractures (15/130; 11.5%) hypocalcaemic seizures (11/130; 8.5%;), and dilated cardiomyopathy (4/130; 3%) Two children died of dilated cardiomyopathy from vitamin D deficiency. The commonest associated conditions were cows milk protein allergy (19/51; 19%; ) iron deficiency (8/51; 7%) and eczema (8/51; 7%) At the time of diagnosis 77% of children were not receiving vitamin D supplements. 19 children had rickets despite being reported to be receiving appropriate supplementation. All confirmed radiological cases had either high parathyroid hormone and/or low phosphate. Following diagnosis, most clinicians initially prescribed treatment themselves, with huge variation in duration of prescriptions. In a further 10 cases, rickets was confirmed but excluded in the incidence analysis, for not meeting the case definition (specifically Vitamin D<25 OHnmol/L), suggesting both dietary calcium deficiency and vitamin D insufficiency as role-players in the presentation of NR in the UK.ConclusionsNR continues to affect children in the UK with serious sequelae. Uptake of vitamin D supplementation remains low and constitutes a failure of current public health policy. A UK national policy focusing on vitamin D and calcium supplementation and adherence is required to eliminate this entirely preventable condition.