Pediatric Nutrition Dilemmas

Question 1

How can Vitamin C deficiency present on HEENT exam?

Answer 1

Buccal mucosa ulcers. (Oral ulcers)

Erythematous gingiva. (Bloody gums)

Question 2

How does Vitamin C deficiency cause bone problems?

Answer 2

Collagen synthesis requires Vitamin C as a co-factor.

Question 3

Can Vit. ADEK deficiency cause anorexia, bone pain with decreased weight bearing, petechiae, brittle nails, etc?

Answer 3

Yep.

Question 4

Hematopoetic effects of Vit C deficiency?

Answer 4

Microcytic anemia - (due to impaired Fe absorption?)

also protects PMNs from intracellular oxidative damage

Question 5

How does Vit C deficiency affect blood vessels?

Answer 5

Causes petechiae, bruises and nodules - without decreasing platelets.

Question 6

In children, what’s the most common presenting complaint of Vit C deficiency?

Answer 6

Pain, limping, and extremity weakness.

Question 7

In what condition do you see corkscrew hairs with hemorrhage in the follicles?

Answer 7

Vit C deficiency.

Question 8

What are 3 places in which you can measure ascorbic acid levels? What does each tell you?

Answer 8

Plasma - reflects dietary intake
Leukocytes - reflects tissue content
Urine…

Question 9

Can low Ca++/Vit D cause seizures?

Answer 9

Yes.

Question 10

What does measuring 25-OH Vitamin D tell you?

Answer 10

This value reflects the body’s stores of vitamin D.

Question 11

What does measuring 1,25(OH)2 D tell you?

Answer 11

This value won’t be low until all the 25-OH Vitamin D has been depleted.

Question 12

Review: What does Vit D deficiency cause in children? In adults?

Answer 12

In children: Rickets - failure of mineralization.

In adults: osteomalcea - softening of mature bone.

Question 13

How are the ribs different in Rickets?

Answer 13

There’s more cartilage - can bead up and make the ribs feel nodular.
“rachitic rosary”

Question 14

What kind of growth is affected in Rickets?

Answer 14

Linear growth.

Question 15

Does rickets increase susceptibility to infection?

Answer 15

Yep.

Question 16

Does Rickets cause bone pain?

Answer 16

Yep.

Question 17

Does Vit D have effects outside the skeletal system?

Answer 17

Yes - deficiency increases risk for cancer, MS, T1D, CD, infections, heart disease.

Question 18

Why can prolonged breast feeding lead to Vit D deficiency?

Answer 18

Breast milk lacks Vit D.

Question 19

Why are premature infants at increases risk of rickets?

Answer 19

A lot of the vitamin acquisition occurs in the last trimester…

Question 20

Deficiency in what mineral can cause increased GI motility, rash, impaired growth? How?
What’s a common reason for deficiency?

Answer 20

Zinc deficiency - It is necessary for DNA replication… so anything dividing cells (skin, gut, hematopoetic, etc) will be affected.
Common cause of deficiency is malabsorption secondary to celiac disease.

Question 21

What rash is particularly seen in Zn deficiency?

Answer 21

Acrodermatitis enteropathica.

Question 22

What can cause the bloating of the abdomen seen in kids with celiac?

Answer 22

Protein depletion -> really low albumin -> water retention -> gut bloating.