Micronutrient Deficiency In Children

Micronutrient deficiencies commonly involve iron, vitamin A, vitamin D, folate, vitamin B12, zinc and iodine. Deficiencies frequently coexist with protein energy malnutrition and chronic disease.

Clinical manifestations may be subtle until deficiency is advanced.

Possible findings include:

• Pallor and fatigue from iron deficiency
• Night blindness or xerophthalmia from vitamin A deficiency
• Rickets from vitamin D deficiency
• Dermatitis and impaired wound healing with zinc deficiency
• Glossitis or megaloblastic anaemia with folate or vitamin B12 deficiency
• Goitre or neurodevelopmental impairment from iodine deficiency

Diagnosis is guided by clinical pattern.

Useful investigations include:

• FBC and blood film
• Ferritin with inflammatory markers
• Vitamin B12 and folate
• Calcium, phosphate and alkaline phosphatase
• 25 hydroxyvitamin D
• Thyroid testing where iodine deficiency or thyroid dysfunction is suspected

Interpret ferritin cautiously during acute inflammation because it is an acute phase reactant.

• Correct the specific deficiency and underlying dietary problem.

• Avoid indiscriminate high dose supplementation when toxicity is possible.

• Children with multiple deficiencies require broader nutritional rehabilitation.

• Investigate malabsorption, chronic diarrhoea, inflammatory bowel disease or other chronic illness when deficiencies recur despite adequate supplementation.