Lessons in early identification and treatment from a case of disabling vitamin C deficiency in a child with autism spectrum disorder

Abstract

Background Autism spectrum disorder is a heterogenous neurodevelopmental condition accompanied by a variety of associated features. Case reports suggest one such associated feature, food selectivity, increases risk for nutritional deficiencies; however, little attention has been given to prevent and treat nutritional deficiencies in youth with autism spectrum disorder. Method Single case report. Results This single case report presents a child with autism spectrum disorder and food selectivity difficulties that resulted in severe vitamin C deficiency. Although eventually corrected, the nutritional deficiency was debilitating, required invasive interventions, and resulted in significant social/emotional and economic costs. Conclusions We review the course of treatment and highlight strategies to prevent and more effectively treat nutritional deficiencies in youth with autism spectrum disorder.

Avoidant/restrictive food intake disorder and severe food selectivity in children and young people with autism: A scoping review

“…This has been shown to result in gagging, spitting, vomiting, self‐injury, and aggression 47,49–51 . Such preferences tend to give rise to a very limited diet, consisting of bland, starchy, and ‘beige’ foods such as crackers, potatoes, rice, and bread products 40,52 …”

“…Aside from the obvious consequences of malnutrition, a number of additional serious health concerns have also been cited in this population. These include chronic constipation, ulcers, visual impairment as a result of vitamin A and B 12 deficiencies, arthritis, laboured breathing, movement difficulties, and liver dysfunction 40,52,56,62,71–73 . For those not getting enough food to meet calorific or nutritional needs, oral nutritional supplements can be a useful way to ensure the adequate intake of macro‐ and micronutrients 39,42,74 .…”

“…The literature on children and young people with autism with severe food restriction reports a number of health issues stemming from the lack or absence of certain micronutrients, including jaundice, anaemia, scurvy, rickets, gingivitis, and hypogonadism. 40,59,61,64,65,[68][69][70] Aside from the obvious consequences of malnutrition, a number of additional serious health concerns have also been cited in this population. These include chronic constipation, ulcers, visual impairment as a result of vitamin A and B 12 deficiencies, arthritis, laboured breathing, movement difficulties, and liver dysfunction.…”

A Narrative Review on Pediatric Scurvy: The Last Twenty Years

“…Although considered a rare disease in high income countries, scurvy has been recently increasingly reported in children [ 55 ]. In literature, the large majority of children with scurvy are reported to have underlying conditions leading to inadequate nutrition such as neuropsychiatric [ 14 , 56 , 57 ] or neurological and developmental disorders [ 3 , 58 ]. Some other diseases can also reduce the absorption of vitamin C (ulcerative colitis, Crohn, Whipple’s and celiac disease) and/or increase the amount needed by the body (hemodialysis, bone marrow transplant, and chemotherapy) [ 3 ].…”

Scurvy: A New Old Cause of Skeletal Pain in Young Children

“…The third scenario is children fed a diet of vegetable milk such as almond milk or other types of milk popular with vegan parents. About 80 pediatric cases have been published in the past 20 years, essentially occurring in children with autism spectrum and neuro developmental disorders [12][13][14][15][16][17][18][19][20][21] but not necessarily [22][23][24]. Vitamin C deficit is more frequent than classical scurvy, as recently shown by a retrospective review of the files of children with low ascorbic level [25].…”