This document discusses various nutritional deficiency disorders, including vitamin and mineral deficiencies that can occur in children. It provides details on the causes, signs and symptoms, and treatment of deficiencies of specific vitamins (A, B vitamins, C, D) and minerals (calcium, iron, iodine). Vitamin and mineral deficiencies can result from inadequate dietary intake, malabsorption issues, increased requirements, or other medical conditions. Deficiencies lead to diseases like rickets, scurvy, beriberi, and anemia, which are described within the document.

1. Nutritional deficiency
disorders
Vitamin & mineral deficiencies
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2. Vitamins
 13 vitamins are necessary for health of a child.
 VitaminsA, D, E, and K are fat-soluble, and all others are
water-soluble
 Fat-soluble vitamins are more readily stored in the body, but
they may be poorly absorbed in fat malabsorption disorders
 A deficiency of vitamins may be primary (dietary in origin) or
secondary because of disturbances in intestinal absorption,
transport in the blood, tissue storage, or metabolic conversion.
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3. Vitamin A deficiency
 Causes of Vit. A deficiency :
◦ Diet deficient in Vit A
◦ Decreased absorption due to chronic
intestinal disorders
◦ Reduced storage in the liver
◦ Increased requirement of Vit A
 Deficiency
◦ Ocular and extraocular lesions
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4.  Ocular leisons
◦ Night blindness- occurs due to the impairment of
dark adaptation. Earliest manifestations of vitamin A
deficiency is impaired vision, particularly in reduced
light
◦ Xerophthalmia- conjunctiva becomes dry, lusterless,
wrinkled with dirty brown color
◦ Bitots spot – triangular area at the temporal aspect
of the limbus covered by a white foamy substance
◦ Keratomalacia- softening, necrosis and ulceration2020/9/25 4Anju George , SGCON, PArumala

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6.  Extraocular lesions
◦ Follicular hyperkeratosis (toad skin/ phrynoderma) –
dry, scaly skin seen over the outer aspects of limbs
◦ Susceptibility to infections- increased susceptibility to
infections due to squamous metaplasia of epithelium.
Epithelium lining the upper respiratory passage and
urinary tract is replaced by keratinizing squamous cells
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7. Treatment
 For xerophthalmia – Orally- Vit A, 2,00,000 IU stat
on the next day and 1-4 weeks later
◦ Half the dose is given to children between 6-12 months
◦ One quarter of the dose is given to children below 6 months
 Acc to national programme for prevention of blindness,
children of 6-11 months should receive 1,00,000 IU of oral
vitamin A and children of 1-5 years should receive 2,00,000 IU
of vitamin A every 6 months in the target areas.
 Encourage diet rich in Vit A
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8. Hypervitaminosis A
 Children and adult ingesting >50,000 IU/day for several
month.
• Vitamin A in excess leads to:
• Nausea , vomiting
• Drowsiness
• Papilledema
• Symptoms of raised intracranial pressure
• In chronic cases children manifest with anorexia, failure to thrive,
alopecia, seborrhic dermatitis, hepatomegaly and tender bone
swelling
• Sclerae may be yellow orange in color which is reversible
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9. Thiamine – Vitamin B1
deficiency
 Deficiency due to diet of polished rice
 Deficiency – beriberi
◦ Two types of beriberi – wet and dry beriberi
 Dry beriberi affects the nervous system
 Clinical features – irritability, fatigue, emotional disturbances,
polyneuritis, headache, calf muscle tenderness, sluggish
tendon reflexes, difficulty in standing from sitting position,
reduced appetite , indigestion, slow growth and constipation.
 Wet beriberi - - the main clinical features are palpitation,
tachycardia, dyspnea and edema
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10.  Infantile beriberi – is classified into 3 types
◦ Cardiovascular type – characterized by tachycardia, dyspnea,
cyanosis, vomiting, shrill cry
◦ Aphonic type - characterized by hoarse cry followed by
aphonia. Terminal manifestations are dysnea, puffiness and
pitting edema
◦ Neurologic type characterized by vomiting, tremors,
convulsions, ptosis, nystagmus, and extraocular muscular
paralysis
 Treatment of Beriberi
◦ Thiamine 10 mg IV on diagnosis for the next 5 days
◦ Oral thiamine 10 mg for 2 times followed by 10 mg oral daily
once for the next 6 weeks
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11. Riboflavin – Vitamin B2
deficiency
 Deficiency is rare and often occurs with other B
vitamin deficiencies. It produces symptoms confined
to skin and mucosa.
 Several months for symptoms to occur
 Burning, watering and itching of eyes
 Photophobia
 Keratitis
 Cheilosis
 Glossitis
 Treatment
◦ Riboflavin 3-10mg orally or 2 mg IM daily for one week
followed by 10 mg orally for 3 weeks
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12. Niacin - Vitamin B3 deficiency
 Cause - Processing of grains removes most of their
niacin content so flour is enriched with the vitamin
 Deficiency – Pellagra which is characterized by ‘Three
Ds’: diarrhea, dermatitis and dementia. Other
neurological and gastrointestinal manifestations are
anorexia, nausea, vomiting , achlorhydria, muscle
weakness and loss of memory.
 Treatment
◦ Oral nicotinamide 50-300mg per day for 2 weeks
◦ Diet rich in B-complex
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13. Pyridoxine – B6 deficiency
 Deficiency is rare
 Deficiency is due to inborn errors of metabolism or
secondary to other disorders like prolonged use of anti
–TB drug such as isoniazid. To prevent it Tab.
Pyridoxine is usually administered with isoniazid
 Clinical features
◦ Nausea, vomiting , diarrhea, hyperacusis, convulsions,
irritability, anemia, failure to thrive.
 Treatment
◦ Pyridoxine 5 mg IM followed by 0.5 mg daily (oral) for 2
weeks.
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14. Folic acid deficiency
 Cause is inadequate intake of folic acid rich
diet.
 Deficiency – megaloblastic anemia, glossitis,
cheilosis, diarrhea, abdominal distension,
flatulence.
◦ Severe deficiency – leads to infertility and
sterility.
 Treatment
◦ Folic acid supplements2020/9/25 14Anju George , SGCON, PArumala

15. Cyanocobalamin – vitamin B12
deficiency
 Mostly seen in strict vegetarians, in patients who
have achlorhydria or who have undergone
gastrectomy, due to the absence of intrinsic factors,
Vit B12 is not absorbed which leads to
megaloblastic anemia (Pernicious anemia)
 Treatment – administration of vitamin B12
parenterally for patients with achlorhydria and
patients who have undergone total gastrectomy.
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16. Ascorbic acid -Vitamin C Deficiency
 Deficiency leads to Scurvy
 Signs and symptoms are :
 Bleeding gums
 Subcutaneous bruising
 Generalized tenderness along the shaft of lower limbs
 Bleeding into the skin or joints, hematuria, malena, subdural
hemorrhages
 Anemia
 Weakness
 Delayed wound healing
 Subperiosteal hemorrhages
 Presence of rosary at costochondral junction
 Treatment – loading dose of Vitamin C 500 mg oral or
parenteral, followed by daily dose of 100-300 mg for
several weeks
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17. Vitamin D deficiency
 Deficiency is Rickets
 Signs and symptoms are :
◦ Reduced calcification of growing bones leads to growth failure and
bone deformity.
◦ Hypocalcaemia leads to muscular hypotonia , tetany and
convulsions
◦ Serum Alkaline phosphatase increased
◦ Protruberant abdomen
◦ Milestones delayed
◦ Disordered eruption of temporary teeth
◦ Craniotabes
◦ Fontanel is wider and closes late
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18.  Bony deformities include :
◦ Curved legs(bow legs or knock knees)
◦ Deformed pelvis
◦ Pigeon chest (sternum is pushed forward )
◦ Harrisons groove – a horizontal depression corresponding to
costal insertion of the diaphragm
◦ Rachitic rosary – palpable enlargement of costochondral junctions
◦ Widening of wrists
◦ Kyphoscoliosis
 Diagnosis – radiological and biochemical measurements
 Treatment –
◦ Expose child to sunshine
◦ Vitamin D supplement intake per oral
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19. MINERAL DEFICIENCIES
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20. Calcium
 Hypocalcemia is more common among
LBW babies, babies with PEM, artificially
fed babies, infants of diabetic mother
 Clinical features – tetany and convulsion
 Treatment – calcium 100-200 mg/kg/day
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21. Sodium
 Cause – excessive sweating , diuretic
therapy , diarrhea and water intoxication
 Clinical features – hypotension,
dehydration, shock, lethargy, seizures.
 Treatment –
◦ Addition of salt in diet
◦ IV Administration of normal saline
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22. Iron
 Deficiency – anemia
 Cause – increased demand, decreased
intake, decreased intake , worm infestations,
blood loss and malabsorption. LBW babies
are more prone to Iron deficiency anemia
 Treatment –
◦ Iron supplements
◦ Correcting underlying pathology
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23. Trace elements – iodine
 Deficiency causes simple goiter,
hypothyroidism, still birth, CNS defects
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