Published online June 22, 2007
PEDIATRICS Vol. 119 No. 3 March 2007, pp. e783-e790 (doi:10.1542/peds.2006-1071)
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EXPERIENCE & REASON

Scurvy and Rickets Masked by Chronic Neurologic Illness: Revisiting "Psychologic Malnutrition"

James McCallum Noble, MDa, Arthur Mandel, MD, PhDa,b and Marc C. Patterson, MD, FRACPa,b

a Departments of Neurology
b Pediatrics, Morgan Stanley Children's Hospital of New York and the Neurological Institute of New York, Columbia University Medical Center, New York, New York

ABSTRACT

The North American epidemic of overeating, combined with a sedentary lifestyle, has led to a growing prevalence of obesity, diabetes, and the "metabolic syndrome" in children. Excessive caloric intake does not imply adequate nutrition, and vitamin-deficiency syndromes still occur in some American children. Here we describe cases of scurvy and vitamin D deficiency in 2 children with cognitive disorders. Thorough dietary histories suggested the diagnosis in each patient and, had they been obtained at presentation, would likely have obviated invasive diagnostic workup, unnecessary stress to the patients and their families, and significant functional disability. Overnutrition and malnutrition may coexist, particularly among those with abnormal cognition or autistic spectrum disorders. Classic nutritional deficiencies must not be omitted from the differential diagnosis. A comprehensive dietary history and screening for vitamin deficiencies in at-risk children are important aspects of preventive health care and are essential for prompt diagnosis and treatment.

Key Words: scurvy • autistic spectrum disorder • vitamin D deficiency • malnutrition • hypocalcemia

Accepted Sep 22, 2006.