Scurvy in Children

Very low intake of vitamin C over time may lead to the deficiency disease scurvy.

Age of Onset:
In infants and young children, the usual age of onset of clinical manifestations of scurvy is 6–24 months.

Early Symptoms:
The early symptoms are rather general and include low-grade fever, irritability, tachypnea, digestive disturbances, loss of appetite, and generalized tenderness, particularly in the legs, which is noticeable when the diaper is changed. The pain results in pseudoparalysis, with the hips and knees semi-flexed and the feet rotated outward.

Other Clinical Features:
Edematous swelling along the shafts of the legs may be present; in some cases, there is subperiosteal hemorrhage at the end of the femur .

A “rosary” at the costochondral junctions and depression of the sternum are other typical features.

Changes in the gums are most noticeable after teeth have erupted and are manifested as bluish purple, spongy swellings of the mucous membrane, especially over the upper incisors.

Anemia, which is seen primarily in infants and young children, may be related to impaired ability to use iron or folate.

Other clinical manifestations seen in infants as well as in older children and adolescents include swollen joints, purpura and ecchymoses, poor wound and fracture healing, petechiae, perifollicular hemorrhages , hyperkeratosis of hair follicles, arthralgia, and muscle weakness. Endochondral bone formation may not proceed because osteoblasts cannot form osteoid. Bony trabeculae that have been formed become brittle and fracture easily. Irritability and other psychologic manifestations are likely due to impaired neurotransmitter metabolism.

Severe vitamin C deficiency may result in degeneration of skeletal muscles, cardiac hypertrophy, bone marrow depletion, and adrenal atrophy.

Treatment
Daily intake of 3–4 oz of orange or tomato juice produces healing in children with scurvy. Vitamin C supplements of 100–200 mg orally or parenterally are preferable to ensure more rapid and complete cure. With proper treatment, recovery, including resumption of normal growth, is rapid, although the swelling associated with subperiosteal hemorrhage may not subside for several months.