Vitamin C Supplement in Children

Vitamin C is an essential water-soluble vitamin. It is found mainly in fresh fruits and vegetables. Milk does not contain vitamin C. But it is present in human breast milk which is essential for newborn babies. There are many vitamin C supplements available to buy, for example, NeoCell Super Collagen C Type I and III – 250 Tablets. Beauty experts also use vitamin C serum to nourish skin. Sometimes babies do not eat enough nutritious food including citrous food. See here for tips for feeding babies.

• Also known as ascorbic acid, first identified in the 1920s by Albert von Szent Györgyi, who discovered that it was able to prevent and cure scurvy.
• Ascorbic means “anti-scurvy.” “ascorbic acid” comes from the New Latin “scorbutus” meaning scurvy.
• Essential water-soluble micronutrient.
• 60-70% of vitamin C is lost in the process of cooking.
• Vitamin C concentrations in various food substances decrease with time.

Dietary Sources of Vitamin C

The best food sources of vitamin C are

1. Citrus fruits and fruit juices,
2. Peppers,
3. Berries,
4. Melons,
5. Guava,
6. Kiwifruit,
7. Tomatoes,
8. Cauliflower, and
9. Green leafy vegetables.

Who are at risk of vit-C deficiency

1. Children fed predominantly heat-treated (ultrahigh-temperature or pasteurized) milk or unfortified formulas.

2. Children with dietary restrictions due to neuropsychiatric or developmental disorders, autism, cerebral palsy, eating disorders, physical disabilities, etc.

3. Children with intestinal malabsorption syndrome.

4. End-stage renal disease undergoing chronic hemodialysis.

5. Exclusive meat feeding.

Functions of Vitamin C in our body

• Synthesis of collagen at the level of hydroxylation of lysine and proline in procollagen. Collagen type IV is the main constituent of blood vessel walls, skin, and, specifically, the basement membrane zone separating the epidermis from the dermis. Vitamin C allows hydroxylation and transcription of pro-collagen; thus, a lack of this nutrient induces collagen abnormalities.
• Neurotransmitter metabolism: Conversion of dopamine to norepinephrine and tryptophan to serotonin.
• Vitamin C has potential antioxidant properties and stabilizes several other compounds, including vitamin E and folic acid.
• Cholesterol metabolism: Conversion of cholesterol to steroid hormones and bile acids.
• Biosynthesis of L-carnitine.
• Iron metabolism: Vitamin C reduces ferric iron to a ferrous state, helping its absorption. Vitamin C enhances non-heme iron absorption, the transfer of iron from transferrin to ferritin.
• Hematopoietic function: Helps the enzyme folate reductase to reduce folic acid to tetrahydrofolic acid. It increases the phagocytic action of leukocytes.
• Vitamin C along with Vit-A and E delays the onset of cataracts.

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Vitamin C and Tretinoin

Vitamin C and tretinoin are both effective skincare ingredients for anti-aging. However, it is important to use them correctly to get the most benefit. By applying vitamin C before tretinoin, you can help to protect your skin from irritation and enhance the effectiveness of tretinoin. See more Dynamic Duo: Should You Use Vitamin C Daily with Tretinoin?

Histological evaluation of a topically applied retinol-vitamin C combination

Dietary Needs

The requirement for vitamin C is increased during infectious and diarrheal diseases.

Age with Adequate Intake

• 0–6 months   40 mg
• 7–12 months  50 mg
• 1–3 years   15 mg
• 4–8 years   25 mg
• 9–13 years   45 mg
• 14–18 years   65-75 mg

Absorption is through an energy-dependent process that has two mechanisms: simple diffusion and active transport. Two transporters are involved: SVCTs (sodium-dependent vitamin C transporters) and hexose transporters. The absorption rate is about 85%. The site for absorption is the upper small intestine. The highest ascorbic acid concentrations are in the pituitary gland, the adrenal gland, the brain, leukocytes, and the eyes. Excretion can be as ascorbic acid, via urine. During the deficiency state, reabsorption occurs via the kidney.

Features of Vit-C Deficiency in children

A deficiency of vitamin C results in the clinical presentation of scurvy.

• Irritability
• Loss of appetite
• Low-grade fever
• Musculoskeletal pain
• Tenderness in the legs
• Difficulty in walking
• Leg swelling
• Gums become spongy purple, swollen, loosened, and bleed on the slightest pressure
• Epistaxis
• Extreme bone and joint pains
• Painful scorbutic rosary
• Pallor
• Perifollicular haemorrhages
• Poor wound and fracture healing
• Hyperkeratosis of hair follicles
• Arthralgia, and muscle weakness

The clinical spectrum of scurvy is discrete and patients can presented with isolated clinical findings.

Radiological findings of scurvy

• The typical radiographic changes occur at the distal ends of the long bones and are particularly common at the knees and ankles.
• Ground glass appearance due to trabecular atrophy.
• Pencil thin cortex
• The white line of Fränkel – an irregular but thickened white line at the metaphysis, represents the zone of well-calcified cartilage.
• Trümmerfeld zone: a linear break in the bone that is proximal & parallel to the white line represents an area of debris of broken-down bone trabeculae and connective tissue. (German word for “field of rubble”).
• Pelkan spur – lateral prolongation of the white line.
• Wimberger sign: circular, opaque radiologic shadow surrounding epiphyseal centers of ossification, which may result from bleeding
• Sub-periosteal hemorrhage when calcified.

Other Investigations

• Plasma ascorbate concentration: < 0.2 mg/dl –deficient
• Buffy coat: leucocyte concentration of ≤ 10 µ g/10⁸ – deficient
• Urinary excretion of Vit C: Measurement of urinary excretion after parenteral ascorbic acid infusion. After 100 mg of an intravenous dose of vitamin C, 80% should be excreted within 5 hours if the body stores are sufficient.

Vit-C deficiency may occur concurrently with other nutritional deficiencies such as thiamine (vit-B1), pyridoxine (vit-B6), cobalamin (vit-B12), and vit-D and this should be kept in mind while investigating scurvy.

Treatment of Vit-C Deficiency

• Vit-C supplements of 100-200 mg/day orally or parenteral.
• The clinical improvement is seen within 1 week in most cases, but the treatment should be continued for up to 3 months for complete recovery.

Available formulations in Bangladesh

• Chewable tablet 250mg
• Syrup 100mg/5ml
• Injection 500mg/5ml
• Oral sachet 1000mg/sachet
• Effervescent tablet 1000mg

Prevention:

• Adequate breastfeeding
• Vitamin C-rich food intake regularly.
• Dietary or medicinal supplements for severely malnourished and those with chronic debilitating conditions.

Vitamin C Toxicity

• Daily intake of <2 g of vitamin C is generally without adverse effects in adults.
• Larger doses can cause gastrointestinal problems, such as abdominal pain and osmotic diarrhea. Significant amounts of vitamin C can increase the risk of kidney stones and elevate uric acid and oxalate because it acidifies the urine.
• Vit-C supplementation is contraindicated in blood disorders like thalassemia, G6PD deficiency, sickle cell disease, and hemochromatosis.
• Tolerable upper intake levels ages.

Clinical, laboratory, and radiological features of the selected 15 studies describing 166 children with scurvy.

Source: A Narrative Review on Pediatric Scurvy: The Last Twenty Years, Published June 2022

See also: 8 Factors That Influence Child Growth and Development

Essential Role of Vitamin C and Zinc in Child Immunity and Health

There is increasing evidence that deficiency of vitamin C and zinc adversely affects the physical and mental growth of children and can impair their immune defenses, and supplementation can represent a valid support method, especially in developing regions.

Source

Sources of this post

1. Nelson Textbook of Paediatrics; 21st Edition
2. Essential Role of Vitamin C and Zinc in Child Immunity and Health: Article published in The Journal of International Medical Research 2010; 38: 386 – 414
3. Scurvy in pediatric age group – A disease often forgotten? Article published in Journal of Clinical Orthopedics and Trauma, 05 Jan 2015, 6(2):101-107
4. A Narrative Review on Pediatric Scurvy: The Last Twenty Years published in Nutrients. 2022 Feb; 14(3): 684