Michael Chahwanda

From Jo Churchill MP 
Parliamentary Under Secretary of State for Primary Care and Health Promotion 

Mr Zak Golombeck 
HM Area Coroner, Manchester City 
Manchester City Coroners Office and Court 
Exchange Floor, The Royal Exchange Building 
Cross Street 
Manchester M2 7EF 

39 Victoria Street 
London 
SW1H 0EU 

11 May 2021 

Dear Mr Golombeck, 

Thank you for your letter of 27 January 2021 to Matt Hancock about the death of Michael 
Chahwanda.  I am replying as the Minister with responsibility for child health and I am 
grateful for the additional time in which to do so.  

Firstly, I would like to say how very sorry I was to read the circumstances of baby 
Michael’s death.  I can appreciate how deeply distressing Michael’s death must be for his 
mother and family and it is important we do all we can to learn the lessons from Michael’s 
death to prevent future deaths.  

I have noted carefully your concern about the provision of important information on vitamin 
D supplementation in the postnatal period.  

I wish to assure you that we recognise the need to equip parents with appropriate health 
advice, particularly during the first months and years of their child’s life.  We also recognise 
the need to support professionals working with parents to give individual, tailored support 
for the child and their parents or carers.  That way, we can prevent problems from arising 
in the first place, rather than dealing with the consequences.  

It is distressing that some infants suffer serious harm or even death as a result of vitamin 
D deficiency, and every case is a tragedy.  We are determined to do everything we can to 
prevent these deaths. 

Existing Government advice on vitamin D supplementation is based on recommendations 
from the Scientific Advisory Committee on Nutrition and is clear on the requirements for 
different population groups, such as breastfed infants.  

I am aware that the Royal College of Paediatrics and Child Health (the RCPCH) has 
confirmed that advice on vitamin supplementation is provided in the Personal Child Health 
Record (also known as the ‘red book’1), which, as you know, is a national standard health 

1 Personal Child Health Record (PCHR) | RCPCH 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 and development record given to parents and carers at a child’s birth.  The information and 
advice contained in the red book is constantly under review, and the most recent version 
(version 4.6) was updated in August 2020.  Advice contained in the red book stipulates 
that all pregnant women, babies and young children from birth to five years should have a 
daily supplement containing vitamin D, and it states that breastfed babies need vitamin 
drops from birth alongside breast milk. 

I am informed that the National Institute for Health and Care Excellence (NICE) has 
advised you in its response that it will work with NHS Digital and NHSx as the red book is 
digitised to ensure content is aligned with the relevant NICE guidelines and 
recommendations on vitamin D supplementation.  I am aware that NICE has also 
explained to you the advice contained within its current guideline on Vitamin D supplement 
use in specific population groups2. 

Advice on vitamin supplementation is also provided through a variety of sources such as 
the NHS.UK website and the Start4Life social marketing campaign, which provides advice 
during pregnancy, birth and parenthood.  This includes specific, directive, advice on 
vitamin D supplementation during pregnancy, breast-feeding and for babies and young 
children.  

However, we appreciate that more can always be done, and we will review all NHS.UK 
and Start4Life references to vitamin D to ensure that the requirements for pregnant and 
breast-feeding women and their infants, particularly those with dark skin, are absolutely 
clear.  I will discuss with my fellow Minister, Nadine Dorries, the importance of it being 
talked about between the midwife and mother. 

In relation to the provision of vitamin D supplements to specific population groups at 
increased risk from vitamin D deficiency, the Scientific Advisory Committee on Nutrition is 
responsible for advising the Government on the vitamin D needs of the population.   

In line with advice from the Scientific Advisory Group, the Department has put in place 
measures to provide vitamin D supplements to women and babies who are at increased 
risk.  Through universal health and wellbeing reviews offered to new parents, health 
visitors provide targeted advice to parents on vitamin drops and where to get them.  
Pregnant women, new mothers and children under the age of four who are on low incomes 
and in receipt of defined social security benefits are entitled to free vitamin D supplements 
through the Healthy Start scheme.  Healthy Start Vitamins for women and children contain 
a daily dose of 10 microgrammes of vitamin D.  Under current advice from the Scientific 
Advisory Group, the Department does not plan to change current policy on the guidance 
and provision of vitamin D. 

Finally, you may wish to note that we have just received a report from the Early Years 
Health Adviser, Andrea Leadsom MP, who has been leading a major review into improving 
health outcomes in babies and young children3.  The review will consider the barriers that 
impact on early-years development, including social and emotional factors and early 

2 Overview | Vitamin D: supplement use in specific population groups | Guidance | NICE 

3 https://www.gov.uk/government/news/new-focus-on-babies-and-childrens-health-as-review-launches  

 
 
 
 
 
 
 
 
 
 
 
 childhood experiences, and seek to show how to reduce impacts on vulnerability and 
adverse childhood experiences in this stage of life. 

I hope this response is helpful, and you feel reassured we are working on preventing baby 
deaths from Vitamin D deficiency.  Thank you for bringing these concerns to my attention. 

JO CHURCHILL

2nd Floor 
2 Redmond Place 
London 
E20 1JQ 
United Kingdom 

19 March 2021 

Mr Zak Golombeck  
HM Area Coroner  
HM Coroner’s Office  
Exchange Floor 
The Royal Exchange Building 
Cross Street 
Manchester 
M2 7EF 

Sent via email 

Dear Mr Golombeck, 

I write in response to your Regulation 28 Report, dated 27 January 2021, regarding 
the tragic death of Michael Chahwanda. I would like to express my sincere 
condolences to his family. 

We have considered the circumstances surrounding Michael’s death and the 2 key 
areas of concern raised in your report, which I will respond to in turn. 

1.  To: The Royal College of Paediatrics and Child Health and Department of 
Health and Social Care and The National Institute for Health and Care 
Excellence: To consider an amendment to the Red Book to include specific 
advice for Vitamin D supplementation in the postnatal period to be given by 
the attending Health Visitor. Such advice would be consistent with national 
guidance. 

NICE’s guideline on vitamin D: increasing supplement use among at-risk groups 
(PH56) recommends that the developers of personal child health records (the 'red 
book') should add specific questions about the use of vitamin D supplements (see 
recommendation 8).  

The red book (Personal Child Health Record (PCHR)) is currently overseen by a 
multi-disciplinary group hosted by the Royal College of Paediatrics and Child Health 
(RCPCH). Therefore, we consider the RCPCH will be best placed to consider 
amendments to the current content of the publication with regards to vitamin D 
supplementation. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 However, as the red book is becoming digitalised, NICE will liaise with NHSX and 
NHS Digital to obtain closer alignment between the digital content and NICE’s 
evidence-based guidance. 

NICE also has a guideline on postnatal care up to 8 weeks after birth (CG37). This 
guideline includes advice on breastfeeding, and the management of common and 
serious health problems in women and their babies after the birth, and is currently in 
the process of being updated. The updated draft guideline includes the following new 
recommendation: 

Inform women that vitamin D supplements are recommended for all 
breastfeeding women.  

The draft guideline also cross-references to NICE’s guideline on vitamin D: 
increasing supplement use among at-risk groups (PH56). 

We expect to publish the updated postnatal care guideline on 13 April 2021. 

2.  To: Department of Health and Social Care and The National Institute for 

Health and Care Excellence: To consider an amendment to the guidelines 
so that there is a directive for women (particularly those with an increased 
skin pigmentation and those who are breast-feeding) to take Vitamin D 
supplements. Also, to consider the provision of Vitamin D to women and 
babies who are at an increased risk of Vitamin D deficiency.  

We consider that NICE’s current guideline on vitamin D (PH56) appropriately 
highlights the increased risk of vitamin D deficiency and the need to take vitamin D 
supplements in the population groups you refer to.  

Recommendation 8 highlights the importance of ensuring health professionals 
recommend vitamin D supplement use among specific population groups (including 
infants and children aged under 4, breastfeeding women, and people with dark skin) 
whenever possible, and gives examples of when this could take place, such as 
during routine appointments and health checks, including antenatal and postnatal 
appointments.  

The guideline glossary defines specific population groups as follows: 

Although the entire population of the UK are at risk of having a low vitamin D 
status, evidence was only considered in regard to increasing the supplement 
use for these specific population groups: 

• All pregnant and breastfeeding women, particularly teenagers and 
young women. 
• Infants and children under 4 years (breast fed, non-breast fed and 
mixed fed). 
• People over 65. 
• People who have low or no exposure to the sun. For example, those 
who cover their skin for cultural reasons, who are housebound or 
confined indoors for long periods. 

                                                                                                                                 Page | 2 

 
 
 
 
 
 
 
 
 
 
 
 
 • People who have dark skin, for example, people of African, African–
Caribbean and South Asian origin. 

All population groups are currently advised to take a supplement that meets 
100% of the reference nutrient intake for their age group. The reference 
nutrient intake levels are noted above. 

All infants and young children aged 6 months to 3 years are advised to take a 
daily supplement containing vitamin D in the form of vitamin drops. But infants 
who are fed infant formula will not need them until they have less than 500 ml 
of infant formula a day, because these products are fortified with vitamin D. 
Breastfed infants may need drops containing vitamin D from 1 month of age if 
their mother has not taken vitamin D supplements throughout pregnancy. 
('Vitamin D – advice for supplements for at risk groups – letter from the UK 
Chief Medical Officers' Department of Health). 

NICE recommends that the Department of Health should work with manufacturers to 
ensure vitamin D supplements are widely available for specific population groups 
including children aged under 4; pregnant and breastfeeding women; and people 
with dark skin, for example, people of African, African-Caribbean or South Asian 
family origin (see recommendation 1). 

In addition, recommendation 6 focuses on how local authorities should improve 
accessibility, availability and uptake of Healthy Start supplements, such as by 
considering offering them free to all pregnant and breastfeeding women and children 
aged under 4 years. 

While it is not mandatory to apply the recommendations made in PH56, they do 
represent the view of NICE, arrived at after careful consideration of the evidence 
available. When exercising their judgement, professionals and practitioners are 
expected to take this guideline fully into account, alongside the individual needs, 
preferences and values of their patients or the people using their service.  

We do not consider that PH56 needs to be amended as a result of your 
correspondence. However, the issues raised by your report will be further considered 
when the guideline is next considered for review. 

Yours sincerely, 

Chief Executive 

                                                                                                                                 Page | 3

Thursday, 25 February 2021 

Dear Coroner Z Golombeck, 

Re: Master Michael Chahwanda 
Regulation 28 – Action to Prevent Future Deaths 

I have read carefully your report regarding the tragic and untimely death of 
Michael Chahwanda and have discussed this with senior colleagues within the 
RCPCH in order to respond to your request.  

You have asked us to consider an amendment to the Red Book to include 
specific advice for Vitamin D supplementation in the postnatal period to be 
given by the attending Health Visitor.   

Attached to this letter is the most recent PDF version of the Red Book, version 
4.6 most recently updated in August 2020. Please refer to page 6 of this 
document on Vitamin D that recommends that all pregnant women, babies 
and young children from birth to 5 years should have a daily supplement 
containing vitamin D. It states that breastfed babies need vitamin drops from 
birth alongside breast milk. This is ratified in the College’s own guidance on 
vitamin D for children.1 

NHS Choices states that all pregnant and breastfeeding women need 10 
micrograms of vitamin D each day and should consider increasing this dose in 
the winter months.2  

It is likely that the sad circumstances surrounding this child’s death is a 
professional practice issue, rather than an omission in College standards or 
guidelines. E-learning is available for child health professionals, including 
health visitors and midwives that signposts to the information hosted on the 
NHS Choices website for guidance around vitamin D supplements.3 These 
materials are endorsed and hosted by Health Education England.  

1 https://www.rcpch.ac.uk/resources/vitamin-d-infants-children-young-people-guidance  
2 https://www.nhs.uk/pregnancy/keeping-well/vitamins-supplements-and-nutrition/  
3 https://www.e-lfh.org.uk/heathy-pregnancy-pathway/antenatal/universal.html  

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Thank you for raising this important case with us.   

Yours sincerely 

President, Royal College of Paediatrics and Child Health