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Case report of nutritional rickets in an infant following a vegan diet

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Abstract

We report the case of a 13-month-old infant who was referred to the pediatric emergency department because of psychomotor regression with four bone fractures due to nutritional rickets. The reason was prolonged breastfeeding from a vegetarian mother followed by a vegan diet for the infant after weaning. Rickets is one of the many nutritional deficiencies that could affect infants fed vegan or vegetarian diets. These diets are a public health concern requiring adapted information that suggests alternative formulas made from rice or soy proteins and adapted supplementation after weaning.

Introduction

Nutritional rickets due to low calcium intake and/or vitamin D deficiency was a common disease in Europe until the mid-20th century [1]. Vitamin D enrichment of infant formulas and systematic supplementation during pregnancy and infancy have decreased the occurrence of this disease significantly. Currently, affected children are more likely to be dark-skinned, receive limited exposure to sunshine on their skin, lack recommended daily supplementation, and/or be exclusively breastfed for a long period by mothers who have had low calcium intake and/or poor vitamin D status during pregnancy (not receiving the recommended supplementation during the third trimester of gestation [1], [2]).

Vegetarian diets exclude all types of meats, fish, shellfish, and crustaceans, but in lacto-ovo vegetarian diets, dairy products, eggs, and honey are tolerated. Vegan diets avoid all animal products such as meat, fish, shellfish, insects, dairy, eggs, and honey. A macrobiotic diet is a vegan diet where only cereals, pulses, vegetables, seaweed, soy, and occasionally fish are consumed. Meats, dairy products, eggs, and some vegetables are usually avoided. The number of infants following these alternative dietary patterns has increased dramatically during the past few decades [3], [4]. This is becoming a real public health concern since vegetarian and vegan diets can induce many nutritional deficiencies in infants including iron, calcium, vitamins D and B12, docosahexaenoic acid (DHA), zinc, and proteins [3], [4]. Nutritional deficiencies are more frequent and severe in young infants fed a non-dairy drink made with almonds, chestnuts, rice, or soya [4].

In this article, we describe a 13-month-old infant on a vegan diet who developed rickets and bone fractures.

Section snippets

Case report

A 13-month-old Eurasian infant was referred to the pediatric emergency department for 1-month psychomotor regression and apathy.

He had no significant neonatal history with a term birth at home. He was seen by a pediatrician on day 12, and then missed all further check-ups, including vaccinations, until the age of 12 months when his parents became worried about a decrease in appetite and weight loss that had begun at 10 months of age. These symptoms were associated with psychomotor regression

Discussion

This case report describes nutritional rickets due to parental ignorance of their child's dietary needs, associated with psychomotor regression and four peripheral fractures. Unfortunately, this infant was not reached by existing prevention measures because of a home birth, refusal of neonatal screening on blotting paper, and a lack of medical check-ups.

Rickets in children is prevented by a vitamin D load in the pregnant woman in the seventh month of pregnancy, and by a systematic

Conclusion

Vegetarian and vegan diets in infants and children have become a public health concern in many European countries [3]. They lead to severe nutritional deficiencies that could irreversibly harm neurologic development or bone mineralization, especially in young infants. Pediatricians must campaign for information to be provided about health risks associated with these alternative diets.

Disclosure of interest

The authors declare that they have no competing interest.

References (10)

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