Fractures of the neck of the femur in children

Summary In a retrospecitve multicenter study we followed-up 30 fractures of the neck of the femur in children aged 11 years (1.5–15 years) for 4.8 years (0.5–20.0 years). It is the aim of this study to analyse factors possibly related to outcome, like age at injury, type of fracture, interval between injury and treatment, method of stabilization and postoperative interval until full weight bearing. At follow-up subjective parameters (pain, weather sensitiveness), clinical parameters (range of motion, claudication, leg length discrepancies) and radiological parameters (hip series) were investigated and medical charts and roentgenograms were reviewed using a standardized protocol. 29 of 30 children (96.7 %) have sustained displaced fractures. Non-operative treatment has been applied in 4 children. 26 femoral neck fractures (type I: 1, type II: 8, type III: 17) were stabilized by internal fixation using screws and/or pins. Following non-operative treatment one child suffered a coxa vara and another child suffered a avascular femoral head necrosis in combination with coxa vara and leg length shortening of 4 cm. Following operative treatment 9 of 26 children (34.6 %) sufferred a avascular femoral head necrosis and 3 children (11.5 %) suffered a coxa vara. In 6 of 26 children (23 %) we observed leg length discrepancies > 2 cm. We were not able to demonstrate any significant follow-up result differencies between the groups of children who have sustained type II or type III fractures, or between the groups of children aged < 10 years when compared to children aged > 10 years, or between the group of children who were operated on within 6 hours after the accident when compared to the group of children operated > 6 hours after the accident. We observed no significant follow-up result differences between the groups of children who had different intervals between operation and full weight bearing. Operative fracture management remains the treatment of choice in the majority of displaced femoral neck fractures in children. However, in our limited study we were not able to demonstrate any significant follow-up result differences between the group of children treated by immediate open reduction and internal fixation (interval injury – operation < 6 hours) when compared to children who had been operated > 6 hours after the injury.      

Radiologic Evaluation of Pediatric Blunt Renal Trauma in Patients with Microscopic Hematuria

As a result of the rapid increase in medical costs, the efficacy of diagnostic imaging is under examination, and efforts have been made to identify patients who may safely be spared radiographic imaging. We reviewed the records of children who presented to our institution with suspected blunt renal injuries to determine if radiographic evaluation is necessary in children with microscopic hematuria and blunt renal trauma. We retrospectively reviewed the medical records of 1200 children (ages less than 18 years) who sustained blunt abdominal trauma and who presented to our level I pediatric trauma center between 1995 and 1997. Urinalysis was performed in 299 patients (25%). Urinalysis results were correlated with findings on abdominal computed tomography (CT). All patients had more than three red blood cells per high power field (RBC/ hpf) or gross hematuria. Renal injuries were graded according to the injury scale defined by the American Association for the Surgery of Trauma. Sixty-five patients had microscopic hematuria. Thirty-five (54%) were evaluated with an abdominal CT scan. Three patients sustained significant renal injuries (grade II-V), and 32 patients had normal findings or renal contusions. Therefore only 3 of 65 patients (4.6%) sustained a significant renal injury. All three patients had other associated major organ injuries. Of the three patients with gross hematuria evaluated with abdominal CT, one (33%) sustained a significant renal injury and had no associated injuries. The degree of hematuria did not correlate with the grade of renal injury. Pediatric patients with blunt trauma, microscopic hematuria, and no associated injuries do not require radiologic evaluation, as significant renal injuries are unlikely. However, children who present with associated injuries and microscopic hematuria after blunt trauma may have significant renal injuries and should undergo radiologic evaluation.     

Psychosocial outcome of patients after ear reconstruction: a retrospective study of 62 patients

This was a retrospective study examining the psychosocial morbidity of patients before and after ear reconstruction. Semistructured questionnaires were sent to 90 patents with significant congenital or acquired auricular deformity 2.2 years (range 3 months to 5 years) following autogenous or osteointegrated reconstruction. Sixty-two patients (69%) responded. Twenty-two of the patients below 12 years, who had undergone reconstructive surgery, also completed the Childhood Experience Questionnaire. These were compared with a cohort of 362 normal patients. There was significant psychosocial morbidity in both children and adults with auricular deformity. Seventy-one percent of patients reported reduced self-confidence that affected both social life and leisure activity. Teasing was a prominent symptom in both children (88%) and adults (85%) but was a motivational factor for surgery in children only. Dissatisfaction with the appearance (73.1%), on the other hand, was the main reason for treatment in adults. Following ear reconstruction, 74% of adults and 91% of children reported an improvement in self-confidence resulting in enhanced social life and leisure activities in both adults and children. There was no difference between osteointegrated and autogenous reconstruction. Sixty percent of patients reported their result as excellent. The patients scored their result better than the surgeon. We conclude that auricular reconstruction has significant psychosocial benefit in the majority of children and adults despite donor-site morbidity and a range of technical result.     

Community ambulation by children with myelomeningocele and high-level paralysis

It has frequently been noted that high-level paralysis precludes community ambulation for children with myelomeningocele. Of the 87 children in our population with high-level paralysis, however, 45 (52%) did achieve community ambulation by 5 years of age, while 42 (48%) did not. There was no significant difference between these two groups by sex, shunt status, scoliosis, or hip surgery prior to 5 years of age. Among the community ambulating group, there were significantly (p less than 0.001) more children who were not retarded, had received physical therapy for walking, and had compliant parents. We concluded, therefore, that community ambulation is a realistic goal for many children with myelomeningocele and high-level paralysis.     

Transcutaneous neuromodulation for the urge syndrome in children: a pilot study.

PURPOSE: Neuromodulation has been used to treat voiding dysfunction in adults. Due to its invasiveness it has rarely been used in children until now with the availability of transcutaneous neurostimulation. We evaluated clinical effects of transcutaneous neuromodulation on detrusor overactivity in children with the urge syndrome. MATERIALS AND METHODS: Between May 1, 1998 and February 28, 1999, 15 girls (mean age 10.2 years) and 26 boys (mean age 10.7 years) with proved detrusor hyperactivity on videourodynamic study underwent neuromodulation. All children had been given anticholinergic therapy previously. Neurostimulation only was used in children in whom anticholinergics had no effect and those who had significant side effects. Anticholinergics were continued in children in whom they had a partial effect. Stimulation of 2 Hz. was applied for 2 hours every day. Surface electrodes were placed at the level of sacral root S3. After 1 month of trial stimulation those children who responded continued the treatment for 6 months, and were evaluated every 2 months. RESULTS: Of the 41 children 15 boys and 13 girls responded after 1 month of trial therapy with an increase in bladder capacity, decrease in urgency, decrease in incontinence and/or better sensitivity. Of the 13 children who did not respond 9 lacked motivation and 4 had no clinical effect despite motivation. After 6 months of therapy a significant increase in bladder capacity, decrease in voiding frequency and decrease in incontinence periods were noted. Adverse effects were not observed. One year after therapy relapse was noted in 7 patients, leaving 21 of 41 children definitively cured. CONCLUSIONS: Although preliminary, our results indicate that transcutaneous neuromodulation can improve symptoms of detrusor overactivity, as response to stimulation was noted in 76% of our patients and 56% were cured after 1 year. This therapeutic option is attractive for children because of its noninvasiveness and absence of adverse effects.     

The overactive bladder in childhood: long-term results with conservative management

PURPOSE: Idiopathic detrusor overactivity has not been thoroughly investigated and its natural history remains largely anecdotal. Bladder overactivity resulting from a neurogenic, anatomical or medical condition has been well described. Therefore, we assessed the long-term results of conservative treatment of children with idiopathic symptomatic refractory detrusor instability. MATERIALS AND METHODS: We reviewed the records of 58 patients who had an isolated finding of uninhibited contractions on urodynamics performed for refractory enuresis and daytime wetting between 1988 and 1994. Study exclusion criteria were chronic urinary tract infection, neurological lesion, anatomical abnormality of the lower urinary tract and less than 12 months of followup. RESULTS: Of the 30 children who met our study inclusion criteria 26 (87%) had complete (21) or significant (5) symptom resolution. Average time to resolution was 2.7 years (range 0.2 to 6.6). Patients with a 50% to 90% bladder capacity expected for age were more likely to benefit from therapy than those with a bladder capacity outside of this range. Age and gender were not significant predictors of resolution although girls were more likely to have resolution than boys. CONCLUSIONS: Idiopathic detrusor instability is amenable to conservative management in the majority of patients during a prolonged period. We advocate thorough urological and urodynamic evaluation to identify idiopathic detrusor instability as an etiology of enuresis and daytime wetting in complicated cases.     

Late results after mitral valve replacement with bileaflet mechanical prosthesis in children: evaluation of prosthesis-patient mismatch

BACKGROUND: Mechanical prosthesis is the choice of valve at the mitral position in children, although re-replacement of prostheses because of prosthesis-patient mismatch is almost inevitable when prostheses were implanted in small children. The methods to predict prosthesis-patient mismatch as a result of patients' somatic growth or pannus formation in children by noninvasive methods have not been well established. METHODS: Thirty-two children underwent mitral valve replacement with 37 bileaflet mechanical prostheses (26 St. Jude Medical prosthetic valves, and 11 CarboMedics prosthetic valves) and were followed up a mean of 6.8 years (maximum 18.3 years) with a complete follow-up rate of 94%. RESULTS: There were no operative deaths and 5 late deaths. Re-replacement of mitral valve because of prosthesis-patient mismatch was required in 5 patients. Freedom from valve-related events and re-replacement of mitral valve at 15 years were 32% +/- 23% and 54% +/- 18%, respectively. Actuarial survival rate was 63% +/- 19% at 15 years. Prosthetic valve orifice area index (manufactured geometric prosthetic valve area divided by patient's body surface area) was well correlated with maximum transprosthesis flow velocity estimated by Doppler echocardiography during follow-up, whereas valve orifice area index had no significant correlation with pulmonary artery wedge pressure assessed by cardiac catheterization. Maximum transprosthesis flow velocity had a significant correlation with pulmonary artery wedge pressure. CONCLUSIONS: Valve orifice area index itself was not a reliable index to predict prosthesis-patient mismatch. Maximum transprosthesis flow velocity was a useful index to predict pulmonary artery wedge. Invasive cardiac catheterization to determine re-replacement of the prosthesis should be considered when maximum transprosthesis flow velocity exceeds 270 cm/s.     

Gastrocutaneous fistula in children after removal of gastrostomy tube: incidence and predictive factors.

BACKGROUND/PURPOSE: Removal of a gastrostomy tube may result in a persistent gastrocutaneous fistula. The authors reviewed their experience to determine the incidence of this event in children, and the factors that contribute to its occurrence. METHODS: Over a 3-year period, 32 children had a gastrostomy tube placed that was subsequently removed. Of these, 18 sites closed spontaneously and 14 had a persistent gastrocutaneous fistula (44%). The groups were similar with respect to age, sex, and diagnosis. Mean time from insertion to removal of the tube was 6.5+/-2 months in the group with spontaneous closure, and 29.8+/-8 months in the gastrocutaneous fistula group (P<.05). RESULTS: One of 17 (6%) children who had tubes removed within 8 months of insertion had a fistula, compared with 13 of 15 (87%) of those who had one removed after 9 or more months (P<.001). Patients with tubes inserted percutaneously (PEG) were less likely to have a fistula than those using the Stamm technique (28% v. 55%, not significant), although PEGs also tended to be in place for a shorter time before removal (12.6 v. 21.1 months). Steroids did not increase the likelihood of a fistula (50% v. 42%, not significant). CONCLUSIONS: The incidence of persistent gastrocutaneous fistula is high after gastrostomytube removal in children. The most important factor predisposing to this problem appears to be the length of time the tube is in place before its removal. Almost all tubes removed within 8 months will close spontaneously.     

Protein energy malnutrition and its recognition in outpatient departments in Venda hospitals.

Between April and June 1988 the number of children under 5 years old attending outpatient departments of Venda hospitals who had protein energy malnutrition (PEM) was determined, the proportions at 3 Venda hospitals were compared, and what percentage of these children was detected by attendant health workers was determined. Approximately 6% had severe PEM; this finding was consistent for all 3 hospitals. The rates for mild PEM were 22% for Tshilidzini and Donald Fraser Hospitals and 33% for Siloam Hospital. This statistically significant difference has not been explained. Health workers failed to recognise about 25% of children with severe PEM and 50% of children with mild PEM. It is suggested that certain interventions and activities are essential if PEM is to be adequately managed: these are efficient monitoring; pre-employment and in-service education for health workers; a breast-feeding and weaning survey; and an investigation of the variation of malnutrition among Venda hospitals.     

Prevalence of Painful Peroneal Tubercles in the Pediatric Population

Pain isolated to the lateral aspect of the heel can be difficult to diagnose, particularly in the growing child. Peroneal tendinopathy or frank tears of the peroneal tendons secondary to an enlarged peroneal tubercle has been implicated as a potential source of pain in adults. Neither the prevalence of enlarged peroneal tubercles in the pediatric population nor the number of symptomatic tubercles in children has been elucidated. We conducted a review of children who presented to our institution with foot and/or ankle pain and who underwent 3-dimensional computed tomography. Initially, a radiographic review was undertaken of all computed tomography scans to determine the prevalence of peroneal tubercles in children. The peroneal tubercles were measured and then classified according to height. The children with tubercles 3 mm or greater in height (adult mean height) underwent a more detailed chart review to evaluate for the incidence of painful tubercles. During the study period, 2,689 children were seen for foot and ankle pain, and 367 underwent a computed tomography scan during their treatment course. Of these 367 patients, 57% had a measurable peroneal tubercle, and 162 (44%) met the criteria for chart review. Only 3 adolescents (1.9%) were found to have clinical symptoms and ultimately underwent surgical excision with successful relief of symptoms. Peroneal tubercle hypertrophy appears to exist in the pediatric population; however, in contrast to adults with associated peroneal tendinopathy and tears, the children in our series had isolated painful tubercles without significant tendinopathy. The clinical examination is important in the diagnosis, and treatment by excision appears to be successful. Although a relatively rare etiology of pain, it is important that treating physicians keep this pathologic process in the differential diagnosis, because conservative management might not reduce the pain in these children.     

Speech and hearing problems in a high-risk population.

A retrospective study was conducted on 85 neonatal intensive care unit (NICU) survivors, all of whom had been mechanically ventilated. Mean birth weight was 1,726 +/- 778 g and mean gestational age was 32.3 +/- 3.8 weeks. Infants were evaluated for various risk factors previously reported to cause hearing loss. Language development was assessed using the Early Language Milestone (ELM) scale and hearing was tested by free field responses (FFR). Twenty-four children (28.2%) had an abnormal ELM or FFR result. Seventeen children failed an FFR; 14 of these were normal on follow-up and 3 defaulted. There was thus no permanent sensorineural hearing loss in the sample assessed. Eleven children failed an ELM, of whom 5 had speech problems on long-term follow-up. There was a significant correlation between the ELM and neurodevelopmental scores (P = 0.045). Intraventricular haemorrhage also correlated significantly with the ELM score (P = 0.0016). Thus the overall incidence of hearing loss in this NICU population was low, but there was a significant occurrence of speech problems, which correlated with neurological damage.     

Gastroesophageal reflux: a significant association with central nervous system disease in children

An association between gastroesophageal reflux (GER) and central nervous system (CNS) disease has been suggested, but not defined clearly in children. We report on 613 children (ages 1 week to 16 years; mean, 16 months) studied at three institutions who were referred to the pediatric surgical service for documentation of GER by an abnormal pH score derived from 18- to 24-hour esophageal pH monitoring. Follow-up (range, 1 to 115 months; mean, 25 months) was obtained in 368 patients. One hundred thirty-two children had CNS disease documented prior to the evaluation for GER. In children older than 1 year, there was an increased incidence of GER (31/45, 69%) in those children with CNS disease compared with those without CNS disease (38/81, 47%; P = .014). On follow-up, only 4.6% (14/282) of children who were not diagnosed initially with CNS disease were found later to have overt CNS disease. There was no significant difference in the prevalence of newly diagnosed CNS disease in children with and without GER in long-term follow-up. In conclusion, in the population of children referred to the pediatric surgeon for evaluation of GER, children older than 1 year with CNS disease are at high risk to have associated GER documented by extended esophageal pH monitoring. Despite this association, those children with GER and no obvious CNS disease do not appear to be at increased risk to develop CNS disease.     

High risk of loss to follow‐up among South African children on ART during transfer,a retrospective cohort analysis with community tracing

Introduction : Decentralization of HIV care for children has been recommended to improve paediatric outcomes by making antiretroviral treatment (ART) more accessible. We documented outcomes of children transferred after initiating ART at a large tertiary hospital in the Eastern Cape of South Africa. Methods : Electronic medical records for all children 0–15 years initiating ART at Dora Nginza Hospital (DNH) in Port Elizabeth, South Africa January 2004 to September 2015 were examined. Records for children transferred to primary and community clinics were searched at 16 health facilities to identify children with successful (at least one recorded visit) and unsuccessful transfer (no visits). We identified all children lost to follow‐up (LTF) after ART initiation: those LTF at DNH (no visit >6 months), children with unsuccessful transfer, and children LTF after successful transfer (no visit >6 months). Community tracing was conducted to locate caregivers of children LTF and electronic laboratory data were searched to measure reengagement in care, including silent transfers. Results : 1,582 children initiated ART at median age of 4 years [interquartile range (IQR): 1–8] and median CD4+ of 278 cells/mm³ [IQR: 119–526]. A total of 901 (57.0%) children were transferred, 644 (71.5%) to study facilities; 433 (67.2%) children had successful transfer and 211 (32.8%) had unsuccessful transfer. In total, 399 children were LTF: 105 (26.3%) from DNH, 211 (52.9%) through unsuccessful transfer and 83 (20.8%) following successful transfer. Community tracing was conducted for 120 (30.1%) of 399 children LTF and 66 (55.0%) caregivers were located and interviewed. Four children had died. Among 62 children still alive, 8 (12.9%) were reported to not be in care or taking ART and 18 (29.0%) were also not taking ART. Overall, 65 (16.3%) of 399 children LTF had a laboratory result within 18 months of their last visit indicating silent transfer and 112 (28.1%) had lab results from 2015 to 2016 indicating current care. Conclusion : We found that only two‐thirds of children on ART transferred to primary and community health clinics had successful transfer. These findings suggest that transfer is a particularly vulnerable step in the paediatric HIV care cascade.     

Sex ratio of male sex preselected children born to couples with exclusively female offspring.

The present study was undertaken to determine if couples with exclusively female children had a decreased probability of a male child after using male sex preselection. Selection criteria for subjects necessitated that couples have had only female children previously and had produced a child at one of 14 centers after using protocol 3 (n = 70) and modified 3 (n = 28) male sex preselection. Prior to sex selection, protocol 3 couples produced a combined total of 135 female children for an average of 2.01 (range 1-4) females per couple; modified 3 couples produced a combined total of 62 female children for an average of 2.21 (range 1-4) females per couple. The normal approximation to the binomial distribution was used to determine significant differences between the sex ratios prior to and after male sex preselection. For couples using protocol 3 there were significant differences in the sex ratio prior to sex preselection (0%) and after sex preselection (73.0%) (p less than .00003). There were also significant differences between the sex ratio prior to modified 3 (0%) and after sex preselection (86%) (p less than .00003). Couples using male sex preselection do not have a decreased probability of a male child if they have had exclusively female children.     

Absence of sensorineural hearing loss in treated infants and children with congenital toxoplasmosis.

Educationally significant hearing loss has been reported in 10% to 15% of children with congenital toxoplasmosis. As part of a pilot study to assess feasibility and safety of prolonged therapy for congenital toxoplasmosis, 30 congenitally infected infants and children were evaluated for auditory function. Serial testing, beginning within 2 months of birth, was performed. Availability of auditory brainstem response (ABR) testing made evaluation at an earlier age than previously possible. Six (20%) of the 30 infants had mild to moderate conductive type hearing loss associated with otitis media. No infant or child had sensorineural hearing loss. The better outcome we observed compared to previous reports of a 15% to 26% incidence of sensorineural hearing loss and 10% to 15% incidence of educationally significant, bilateral hearing impairment may be related to early initiation and/or prolonged institution of antimicrobial therapy. Continued followup to exclude progressive hearing impairment and study of larger numbers of children are needed to verify these preliminary findings.     

Longitudinal pulmonary function of childhood bronchiectasis and comparison with cystic fibrosis

BACKGROUND: Little has been published on the progression of non-cystic fibrosis bronchiectasis (BX), especially in childhood. Data are needed for prognosis and evaluation of the effectiveness of treatments. A study was undertaken to evaluate the change in lung function over time in children with BX, and to consider covariates and compare them with the local cystic fibrosis (CF) population. METHODS: Children with BX or CF and > or =3 calendar years of lung function data were identified from hospital clinics. Diagnosis was made by high resolution CT scans, sweat tests, and genetic studies. Lung function performed on a single plethysmograph between 6 and 15 years of age and > or =6 weeks after diagnosis was analysed longitudinally (linear mixed model). The impact of reference equation and "best annual" versus "all data" approaches were evaluated. RESULTS: There were 44 children in each of the BX and CF groups with an overall mean 5.7 calendar years follow up data. The estimated forced expiratory volume in 1 second (FEV(1)) in the BX group had an intercept of 68% predicted (Polgar) at 10 years of age which fell at a rate of 1.9% per annum using "best annual" data compared with 63% and 0.9% using "all data". Those with post-infectious BX or chronic Haemophilus influenzae infection had more severe disease. In CF the FEV(1) ("best annual") intercept was 85% predicted with a slope of -2.9% per annum. The choice of reference equation affected the magnitude of the result but not the conclusions. CONCLUSION: Children with BX have significant airway obstruction which deteriorates over time, regardless of analysis strategy or reference. Effective interventions are needed to prevent significant morbidity and adult mortality.     

Nephrocalcinosis in X-linked hypophosphatemia: effect of treatment versus disease

While the literature has suggested that vitamin D and phosphate therapy benefits children, and possibly adults, with X-linked hypophosphatemia (XLH), there have been increasing reports of nephrocalcinosis by renal ultrasound examination in treated patients. Although it has been assumed that nephrocalcinosis is the result of treatment, there has been no systematic comparison of treated and untreated XLH patients with long-term follow-up. Therefore, we studied 10 adults and 4 children by renal ultrasound examination with no history of medical therapy and 10 adults and 8 children with a history of medical therapy. None of the untreated patients had nephrocalcinosis; 5 treated adults and 5 treated children had nephrocalcinosis. In 3 of 4 treated children, serial renal ultrasounds did not show progression of the nephrocalcinosis. One patient progressed from baseline to year 1 only. Comparisons of means between treated patients without and with nephrocalcinosis showed statistically significant differences for urine calcium/creatinine ratios and urine phosphorus/creatinine ratios, differences not seen between untreated patients and treated patients without nephrocalcinosis. Phosphate dose, but not vitamin D dose, was statistically significantly different between the two treated groups. Our studies point to a convincing role for the association between nephrocalcinosis, as diagnosed by renal ultrasound examination, and medical therapy.     

Surgical management of epilepsy using epidural recordings to localize the seizure focus. Review of 100 cases

One hundred patients with focal epilepsy (44 were children) were evaluated with extraoperative electrocorticography via epidural electrode arrays. Localization of the epileptogenic focus was derived predominantly from recordings made during spontaneously occurring seizures. All resection procedures were carried out under general anesthesia. During anesthesia, the recording of sensory evoked responses made it possible to readily identify the sensorimotor region. Of the 100 patients, 72 underwent resection of an epileptogenic focus, and 33 of these were children. Those who did not have a resection either exhibited a diffuse seizure focus, failed to show an electrical seizure discharge in association with the clinical seizure, failed to have a seizure during the period of monitoring, or failed to exhibit conclusive changes for identifying a focus in the interictal record. Fifty-seven patients (29 children and 28 adults) who had a resection have been followed for between 1 and 12 years. Eighteen (62%) of the 29 children and 18 (64%) of the 28 adults enjoyed a good result. Twenty of the 100 patients reported here had temporal lobe epilepsy. They were candidates for recordings with depth electrodes to identify their focus, but they were evaluated instead with epidural recordings; the method is described. In 15 of them, a unilateral focus was identified and they underwent an anterior temporal lobectomy. Pathological changes were found in every case and, in 11 patients, the epidural recordings distinguished between a medial and a lateral focus. Ten of these patients have been followed for 9 months to 3 1/2 years, and seven have had a good result. The observations suggest that epidural electrodes may be used in lieu of depth electrodes for identifying the symptomatic temporal lobe.     

Vitamin D status of Icelandic children and its influence on bone accrual

The importance of vitamin D for children’s bone health has been well established, but the effects of less severe deficiency are not fully known. The main objective of this study was to assess the vitamin D status of Icelandic children at the age of 7, and again at 9 years of age, and the association of vitamin D status with bone mineral content and bone accrual over 2 years. We invited 321 children to participate in this study, and 267 (83 %) took part; 211 (79 %) underwent a DXA scan and 164 were again scanned 2 years later; 159 (60 %) vitamin D samples were measured and 119 (75 %) were measured again 2 years later. At age 7, 65 % of the children had vitamin D concentrations <50 nmol/l, and at age 9 this figure was 60 %. At age 7, 43 % of the children had insufficient amounts of vitamin D (37.5–50 nmol/l), and 22 % had a vitamin D deficiency (<37.5 nmol/l). In linear regression analysis, no association was found between vitamin D and bone mineral content. Furthermore, there was no significant difference in bone accrual over 2 years for the children with insufficient or deficient vitamin D at both ages, compared to those having more than 50 nmol/l at both time points. More than 60 % of Icelandic children have inadequate concentrations of vitamin D in serum repeatedly over a 2-year interval. However, vitamin D in the range did not have a significant effect on bone mineral content or accrual at ages 7 and 9.