Vitamin deficiencies in children
Deficiency state _ Symptoms and signs
Vitamin A deficiencies in children
Night blindness, bitot spots on scleral conjunctiva (chalky-grey spots on the temporal side of corneoscleral junction), xerophthalmia, and keratomalacia. Toad-like skin due to follicular hyperkeratosis (phrynoderma), faulty epiphyseal bone formation, mucosal alterations leading to frequent respiratory and GI infections, stunting and formation of renal and vesical calculi.
Vitamin B complex in children
Thiamine (B,): Dry beri-beri (polyneuritis, ptosis, hoarseness of voice, tenderness of calf muscles, sluggish deep tendon jerks) and wet beri- beri (palpitation, tachycardia, dyspnea, cardiomegaly and edema with low voltage, prologned QT interval and inversion of T waves on EKG). Riboflavin (B ): Glossitis (sore, red and glazed tongue), cheilosis and angular stomatitis (cracking of the angles of the mouth), scaly dermatitis at nasolabial folds, photophobia and blurred vision due to circumcorneal vascularization and keratitis. Niacin (PP factor or BJ: Pellagra characterized by diarrhea, dermatitis (over parts of skin exposed to sunlight), and dementia (muscle weakness, loss of memory, depression and lethargy). Pantothenic acid (B) Burning sensations in hands and feet, gastrointestinal disturbances, muscle cramps, fatigue and hypoglycemia. Pyridoxine (BJ. Hypochromic anemia, irritability, seizures and peripheral neuritis. Biotin (B,): Hair loss, scaly erythematous rash around eyes, nose, mouth and genital area. Folic acid or folate (B): Megaloblastic anemia, glossitis, pharyngeal ulcers and impaired immunity. Cyanocobalamin (B,): Anemia, pigmentation of knuckles, thrombocytopenia, and tremors.
Vitamin C (ascorbic acid) deficiencies in children
Scurvy characterized by marked irritability, hemorrhages under the periosteum of long bones (pseudoparalysis with frog-like posture), gums, mucous membranes and skin, and scorbutic rosary (posterior dislocation of stemum). Angulation of “scorbutic beads” is seen unlike rickets where swelling is rounded or dome-shaped. There is increased risk of infections and poor wound healing.
Vitamin D (cholecalciferol) deficiencies in children
Rickets characterized by bossing of skull, craniotabes, delayed closure of anterior fontanel, costochondral beading (rachitic rosary which is broad, smooth and dome-shaped), pigeon-shaped chest, Harrison’s sulcus” (retractions at lower borders of chest corresponding to the insertion of diaphragm), spinal deformities, widening and enlargement of ends of long bones, bowing of legs, knock knees, coxa vara, pot- belly, etc. Stunting is common and tetany may occur.)
Vitamin E (tocopherol)deficiencies in children
Hemolytic anemia in preterm babies, progressive neuromyopathy manifesting as ataxia, muscular cramps, and paralysis of extrinsic ocular muscles.
Vitamin K deficiencies in children
Early and late-onset hemorrhagic disease of the newborn with bleeding manifestations from different sites. mamins A,D,E and K are fat-soluble while vitamins B complex and C are water-soluble vitamins. Harrison’s sulcus is also seen in children with obstructive airway disease or enlarged adenoids.
VITAMIN DEFICIENCY DISEASES
Functions of various vitamins with their sources and effects of deficiency . Clinical features and treatment of Scurvy and Rickets is discussed here.
Vitamin C deficiency is more common in top fed babies. It may be precipitated during acute illness like gastroenteritis.
Symptoms and Signs
1. Onset may be sudden or insidious.
2. The child may complain of pain in legs. On examination there may be swelling and tenderness around major joints. In severe cases mobility of limbs is restricted, it may mimic like poliomyelitis but the deep reflexes are well elicited.
3. Bleeding from gums: In initial stages there may be just purple line at the junction of teeth and gums.
4. Petechial hemorrhagic patches on skin.
5. Scorbutic beading: These are ob- served at costochondral junction but they are sharper than rachitic beading.
6. All these features may be associated with low grade fever.
7. Rarely there may be hematuria and melena.
X-ray picture of upper limbs may show following changes-
1. Ground glass appearance of cortex of long bones.
2. Signet ring appearance of epiphysis.
3. Separation of periosteum from shaft due to subperiosteal hemorrhage.
4. Thinning of cortex of long bones.
5. Increased density at end of long bones. (white line of Fraenkel)
1. Symptomatic treatment Movements of the tender limb should be avoided. Analgesic, An- tipyretic- Syr. Paracetamol (Crocin) 30-40 mg/kg/day in divided doses.
2. Specific treatment Daily requirement of Vit. C in children is 20 mg/kg/day. In severe cases 100-200 mg/day may be given for 1 to 2 weeks. Child should be encouraged to have natural food sources of Vitamin Ilike orange, lime juice, etc.
Causes of Rickets
1. Poor intake of Vitamin D
2. Poor absorption of Vitamin D
3. Vitamin D resistant rickets: Renal rickets
Symptoms and Signs
1. Head i. Frontal prominence: Frontal bosses ii. Hot cross bun appearance of vault of the skull iii. Craniotabes: Softening of posterior part of the skull
2. Upper and lower limbs Epiphyseal widening at wrist and ankle. i. ii. Double malleolus iii. Knock-knee and bow legs
3. Thorax Rachitic beading i. ii. Sternal prominence- pigeon breast. iii. Funnel shaped depression of lower part of sternum.
4. Vertebral column Usually there is a scoliosis in severe cases.
5. Other features Pot belly, hepatosplenomegaly, and excessive sweating overhead.
1. Many a times clinical features ar sufficient to start the treatment. Skeletal X-ray or X-ray of chest is not always necessary for the diagnosis of rickets. X-ray of wrist with fore-arm- i. Fraying and cupping of distal of radius and ulna. ii. Enlarged metaphysis. ii. Decreased density of bone shaft.
2. Serum vit. D: It is decreased in rickets. In Vitamin D resistant rickets, inves- tigations like serum calcium, alkaline phosphates are required. Such cases should be hospitalized for further in- vestigations.
Vitamin D: 3 to 6 lacs units IM. (Inj. Arachitol) or orally. Oral preparations (Mashyne granules) are better accepted by the children. 2nd dose may be repeated after 3 to 6 weeks. After this the child should be kept on maintenance dose of 400 IU/day. The child should be encouraged to have natural sources of Vit. D like milk, egg yolk, cod liver oil pearls.
Nutrition is defined as adynamic process in which ingested food is used for nurishing the body.