Editor’s Note: Elizabeth Zeichner (she/her) is a former high school teacher and a resident physician in pediatrics at the Children’s Hospital of Philadelphia. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
As pediatricians, we counsel patients on eating a varied diet with fruits and vegetables to ensure adequate vitamin and nutrient intake. Scurvy, or vitamin C (ascorbic acid) deficiency, has been an uncommon diagnosis. However, there have been increasing reports since 2000 on the rising incidence of pediatric scurvy.
This week, Pediatrics is early releasing a research brief, “Characteristics of Pediatric Scurvy Hospitalizations: 2006-2021,” by Kathleen Murphy, DO, Quinn Weisman, MD, and colleagues from the Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania (10.1542/peds.2024-065782). The authors used the Pediatric Health Information System (PHIS) database to conduct a multicenter retrospective repeated cross-sectional study exploring children hospitalized with scurvy from 2006 to 2021.
The authors identified 138 unique patients from 33 hospitals who had a primary diagnosis of scurvy, ascorbic acid deficiency, or vitamin C deficiency. They excluded patients with admissions for primary diagnoses that could also affect nutrition (such as cancer or short bowel syndrome).
Patients diagnosed with scurvy had a median age of 7 years, and 78% were male. They often had other comorbid diagnoses, including autism (60%) or other neurodevelopmental disorders (19%), as well as iron deficiency anemia (43%).
The authors discuss the high cost and diagnostic testing burden of these hospitalizations: patients had a median length of stay of 5 days and a median cost of admission of $17,082. Patients underwent multiple diagnostic tests throughout their hospitalizations, from x-ray (70%) to bone marrow/bone biopsy (17%).
We need to include pediatric scurvy in the differential diagnosis for patients with any of the following symptoms:
- Joint swelling and tenderness
- Refusal to bear weight
- Rash
- Petechiae
- Bleeding
- Fever
- Irritability
This study reminds us to think about the possibility of pediatric scurvy, especially with selective eating habits, which are often seen in patients with neurodevelopmental disorders.
