Pediatric scurvy and eating disorders: the feasibility of a tasteless, odorless multiple-micronutrient powder for avoidance of tube feeding

Abstract Background Scurvy has re-emerged in association with neurodevelopmental and eating disorders, particularly selective eating. This study aimed to investigate the clinical characteristics of pediatric scurvy cases. Methods We retrospectively assessed the data of pediatric patients diagnosed with scurvy at a Japanese medical institution between 2017 and 2023. Clinical characteristics, nutritional profiles, and treatment outcomes were analyzed. Results In total, 13 children, median age 52 months, had scurvy, 92% of whom had confirmed or suspected autism spectrum disorder; all were diagnosed with an eating disorder. All children also had low serum vitamin C levels, and 85% exhibited multiple nutrient deficiencies. Common symptoms included gait disturbances (85%), joint pain (69%), and fever (46%). Eight patients (62%) were misdiagnosed by their previous doctor. In the acute phase, the median symptom resolution time was 10 days by administration of vitamin C. In the chronic phase, despite nutritional counseling and education, none of the patients were able to consume enough vitamin C by food, and the prescribed vitamin formulation was not taken in 4 of 9 patients (44%) owing to hypersensitivity. Treatment with odorless, tasteless, multiple-micronutrient supplements containing vitamin C was successful in all 11 patients who attempted it. Conclusions All cases of pediatric scurvy in this cohort were caused by an eating disorder, neurodevelopmental disorder, physical disease, or a combination thereof. The diverse clinical course and misdiagnosis in some cases underscore the importance of a detailed dietary history for diagnosis. In terms of treatment, all patients in this study had very limited oral food owing to autism, but none required tube feeding, indicating that tasteless, odorless, multiple-micronutrient supplement powders might be beneficial in reducing the need for tube feeding in children who cannot take the prescribed vitamin formulation orally.