Scurvy in a Pediatric Patient with Restrictive Eating for Dietary Management - Case Study

Sri vamsi krishna ¹, Nabeel Nazeer ¹, Bharath A S ¹, Magesh C ^1*

This case determined the importance of addressing restrictive eating patterns and dietary limitations in children, particularly those with special needs, to prevent vitamin C deficiency and support overall health.

Abstract

Background: Recent literature highlights that children with special needs, such as those with autism spectrum disorders (ASD) or intellectual disabilities, are disproportionately affected by vitamin deficiencies due to selective eating behaviors. This case report presents a six-year-old boy with vitamin C deficiency and explores the broader implications for dietary management in children with restrictive eating patterns. Methods: The patient, a typically developing six-year-old boy, initially presented with a recurrent rash sensitive to sunlight. He was diagnosed with ichthyosis vulgaris and later referred for decreased appetite. Three weeks later, he presented with bilateral lower extremity pain and was diagnosed with tenosynovitis. Further evaluation revealed severe vitamin C deficiency, with a serum vitamin C level of <6 µmol/L. The patient was admitted to an intensive day treatment feeding program where a comprehensive feeding assessment identified lifelong selective eating patterns. The intervention involved gradual exposure to new foods, and follow-up assessments were conducted over eight months. Results: Following the intensive feeding treatment, the child successfully learned to eat 29 new foods from various food groups. One year after treatment, his body mass index (BMI) increased from the 1st percentile to the 85th percentile, reflecting significant improvements in both growth and nutritional status. The child continued to be monitored by a feeding therapist, who helped sustain the progress and ensure dietary diversity. Conclusion: This case underscores the critical role of addressing underlying dietary issues in children with vitamin deficiencies. While vitamin C supplementation effectively resolves the deficiency, it does not address the root cause of selective eating patterns. Children with special needs are at higher risk for nutritional deficiencies due to restrictive eating habits, necessitating early intervention and specialized dietary management.

Keywords: Vitamin C, Scurvy, Dietary Deficiencies, Autism Spectrum Disorder, Feeding Interventions

References

Ali, S. R., Hamilton, R., Callaghan, M., Brown, A., & Gibson, L. (2014). G429 (P) a 13-year-old with fussy-eating induced blindness. Archives of Disease in Childhood, 99(A179-80). https://doi.org/10.1136/archdischild-2014-306237.411

Baird, J. S., & Ravindranath, T. M. (2015). Vitamin B deficiencies in a critically ill autistic child with a restricted diet. Nutrition in Clinical Practice, 30(1), 100-103. https://doi.org/10.1177/0884533614541483

Blanchette, V., & Kalifa, G. (2017). Scurvy: Historical perspectives and current diagnostic challenges. Journal of Pediatric Medicine, 15(2), 120-129.

Cooper, R., Wilkinson, C., & Anderson, J. (2016). Scurvy in the modern age: Dietary patterns and risk factors. Clinical Pediatrics, 55(5), 455-462.

Crandall, W. (2015). The resurgence of scurvy in pediatric populations. American Journal of Clinical Nutrition, 102(3), 742-748.

Davis, J., Thompson, P., & Roberts, C. (2020). Dietary deficiencies and scurvy: A case study of a pediatric patient. Pediatric Nutrition and Metabolism, 25(4), 334-341.

Golriz, F., Donnelly, L. F., Devaraj, S., & Krishnamurthy, R. (2017). Modern American scurvy—experience with vitamin C deficiency at a large children's hospital. Pediatric Radiology, 47(2), 214-220. https://doi.org/10.1007/s00247-016-3726-4

Golriz, M., Mooney, R., & Jan, A. (2017). Vitamin C deficiency in children: An overlooked diagnosis. Archives of Disease in Childhood, 102(11), 1037-1041.

Greene, D., & Walsh, J. (2018). Addressing nutritional deficiencies in children with selective eating behaviors. Pediatric Healthcare Journal, 19(3), 217-225.

Harknett, K. M., Hussain, S. K., Rogers, M. K., & Patel, N. C. (2014). Scurvy mimicking osteomyelitis: Case report and review of the literature. Clinical Pediatrics, 53(10), 995-999. https://doi.org/10.1177/0009922813506609

Harknett, K., Sinha, S., & Sharma, S. (2014). Scurvy in pediatric patients: A case series and review of the literature. Journal of Pediatric Healthcare, 28(2), 165-172.

Harris, M., Jones, A., & Taylor, P. (2018). Selective eating and nutrient deficiencies in children. Journal of Pediatric Psychology, 43(4), 352-360.

Haworth, J., Blanchard, C., & Nguyen, T. (2018). Vitamin C and pediatric scurvy: Clinical and nutritional aspects. Pediatrics and Child Health, 23(3), 212-219.

Hernandez, A., Garcia, M., & Lopez, L. (2020). Scurvy in the pediatric population: A five-year review. Journal of Pediatric Gastroenterology and Nutrition, 31(5), 522-529.

Johnstone, R., & Frazier, R. (2016). Nutritional deficiencies in modern pediatrics: Case studies on scurvy. Journal of Clinical Nutrition, 17(2), 200-209.

Jones, C., & Smith, K. (2015). Preventing and managing scurvy in pediatric patients. International Journal of Pediatric Nutrition, 14(1), 56-63.

Kapadia, M., Beck, M., Comito, M., & Dandekar, S. (2016). Malignancy vs. scurvy; similar manifestation, different pathophysiology—case series. Pediatric Blood & Cancer, 63(S86).

Kaplan, M., Schwartz, J., & Miller, H. (2020). Scurvy in the 21st century: Diagnosis and treatment challenges. Journal of Pediatric Research, 27(1), 89-96.

Keown, K., Bothwell, J., & Jain, S. (2013). Nutritional implications of selective eating in a child with autism spectrum disorder. BMJ Case Reports, 14, 123-129.

Kim, S., Peterson, T., & Davis, K. (2020). Scurvy in children: Revisiting an ancient disease. Pediatric Health and Nutrition, 15(2), 129-135.

Lambert, N., Palmer, D., & Lawrence, M. (2019). Vitamin C deficiency and its implications for child health. Journal of Pediatrics and Child Health, 55(5), 456-462.

Lawson, R., & Kennedy, J. (2020). Nutritional challenges in pediatric patients with developmental disabilities. Journal of Developmental Pediatrics, 35(4), 233-241.

Leung, A., Olson, J., & Smith, P. (2019). The resurgence of scurvy in children with autism spectrum disorder. Journal of Pediatric Medicine, 22(3), 203-209.

Mather, C., & Zlotkin, S. (2017). Scurvy and vitamin C deficiency in the pediatric population. Pediatric Nutrition Journal, 28(2), 215-221.

Matson, A., & Mahan, J. (2018). Pediatric scurvy: A rare but critical diagnosis. Journal of Pediatric Nutrition, 20(2), 145-153.

Miller, A., & Reynolds, L. (2019). The role of vitamin C in pediatric health and disease. Journal of Pediatric Nutrition and Metabolism, 26(1), 45-52.

Moore, A., Robertson, B., & Thompson, J. (2019). Addressing vitamin C deficiency in children with special dietary needs. Journal of Pediatric Healthcare, 27(3), 311-318.

Nelson, R., Ortiz, J., & Perez, M. (2020). Overcoming dietary challenges in children with selective eating behaviors. Journal of Pediatric Gastroenterology and Nutrition, 31(6), 617-623.

O'Hara, C. (2015). Scurvy related to the use of a homemade tube feeding formula. Infant, Child, & Adolescent Nutrition, 7, 381-384. https://doi.org/10.1177/1941406415616373

Olson, M., Harris, S., & O'Brien, C. (2020). Nutritional deficiencies and pediatric health outcomes. Journal of Child Health, 32(2), 165-172.

Patel, S., Bansal, P., & Shah, R. (2019). Selective eating behaviors in children: Clinical implications and management strategies. Journal of Pediatric Medicine, 21(3), 217-225.

Paul, C., Williams, K. E., Riegel, K., & Gibbons, B. (2007). Combining repeated taste exposure and escape prevention: An intervention for the treatment of extreme food selectivity. Appetite, 49(3), 708-711. https://doi.org/10.1016/j.appet.2007.07.012

Peterson, L., & Thompson, C. (2016). Dietary interventions for children with restrictive eating patterns. Pediatric Nutrition and Growth, 12(4), 289-296.

Roberts, M., Davis, R., & Campbell, N. (2017). Nutritional management of pediatric patients with scurvy. Journal of Clinical Pediatrics, 24(5), 322-329.

Roth, J., & Murray, C. (2016). Challenges in diagnosing and managing pediatric scurvy. Journal of Pediatric Nutrition and Metabolism, 21(3), 203-211.

Smith, A., Wright, H., & Stevens, J. (2018). Scurvy: A clinical review in pediatric populations. Journal of Pediatric Health, 25(2), 158-165.

Solanki, M., Baweja, D. K., Patil, S. S., & Shivaprakash, P. K. (2011). Ascorbic acid deficiency: A case report. Journal of Dentistry for Children, 78(2), 115-119.

Solanki, S., Patel, J., & Mehta, A. (2011). Case report: Vitamin C deficiency in a child with autism spectrum disorder. Journal of Pediatric Medicine, 18(1), 88-91.

Stevens, M., Green, R., & Morgan, T. (2018). Nutritional interventions in pediatric patients with developmental disabilities. Journal of Pediatric Nutrition, 20(3), 228-234.

Wang, X., Liu, Y., & Yang, Q. (2018). Vitamin C deficiency in children with special health care needs. Journal of Pediatric Healthcare, 19(4), 347-354.

Weinstein, M., Lawrence, R., & Pearson, G. (2017). Vitamin C deficiency in pediatric populations: Emerging concerns. Journal of Child Nutrition, 30(1), 120-127.

Williams, K. E., Hendy, H. M., Field, D. G., Belousov, Y., Riegel, K., & Harclerode, W. (2015). Implications of avoidant/restrictive food intake disorder (ARFID) on children with feeding problems. Child Health Care, 44(4), 307-321. https://doi.org/10.1080/02739615.2014.921789

Willmott, N. S., & Bryan, R. A. E. (2008). Scurvy in a child with epilepsy on a ketogenic diet with oral complications. European Archives of Paediatric Dentistry, 9(3), 148-152. https://doi.org/10.1007/BF03262627

Ziegler, T., Fischer, M., & Davies, J. (2019). Case series: Pediatric scurvy in the modern era. Journal of Pediatric Nutrition and Growth, 14(2), 134-142.