Recent research has shown that vitamin B deficiency in children occurs more frequently than previously assumed. Vitamin B12 in babies Deficiency usually manifests itself with nonspecific symptoms such as developmental delays, a different growth curve, anorexia, irritability, neurological problems, and fatigue. In case of a divergent growth curve with neurological symptoms or developmental delays, vitamin B12 deficiency should be considered.
The amount of vitamin B12 in the first year of life is highly dependent on how much vitamin B12 is available during pregnancy and is therefore highly dependent on the mother's vitamin B12 status.
Typically, a newborn baby's liver has a store of 25 µg of vitamin B12, which is sufficient for the first year of life, even if subsequent intake is inadequate. However, this depot is severely reduced in mothers with (untreated) vitamin B12 deficiency. This may already become evident at the age of 3 to 4 months.
Vitamin B12 deficiency in the first years of life can lead to decreased function of the central nervous system. Severe clinical symptoms and neurological impairment have been described in children with vitamin B12 deficiency. Even a slight deficiency can have harmful effects. A low vitamin B12 state may exist with normal vitamin B12 serum values and without the classic features of megaloblastic anemia or neuropathy. Timely detection of deficiency and adequate treatment with vitamin B12 can prevent serious and irreparable damage and improve the child's development.
After birth, serum B12 levels drop significantly. From the age of 6 months, the value increases to a maximum between the ages of 3 and 7, then gradually decreases to the adult value. The fact that this decrease continues throughout life indicates that current laboratory reference values should not be applied to children. These reference values are based on healthy adults.
Symptoms of Vitamin B Deficiency in Children
- Weakness,
- Anorexia,
- delay in growth,
- Developmental delay and even regression,
- Irritability,
- Tingling or burning sensation (in extremities),
- Hypotonia (low muscle tone),
- Reduced tactile sensation,
- seizures,
- Ataxia (lack of muscle control),
- stroke symptoms,
- involuntary movements,
- concentration problems,
- memory disorders,
- Personality changes,
- macrocytosis,
- Anemia,
- Hypersegmented neutrophils (type of white blood cells),
- Leukopenia (low white blood cell count),
- Thrombocytopenia (low blood platelet count),
- glossitis,
- Hyperpigmentation of the skin,
- Vomiting,
- Diarrhea and/or intestinal symptoms,
- Jaundice,
- Headache.
Causes of B12 Deficiency
The causes of vitamin B12 deficiency in children can be divided into 3 categories; reduced intake, malabsorption, and congenital errors in the transport and metabolism of vitamin B12.
Reduced intake:
Strictly vegetarian/vegan/macrobiotic diet,
Breastfeeding of a mother with untreated vitamin B12 deficiency or a mother following one of the above diets,
Untreated phenylketonuria (a genetic condition).
Malabsorption:
Autoimmune pernicious anemia, surgical removal of part of the intestine (intestinal resection), insufficient or no intrinsic factor due to absence/abnormal formation of intrinsic factor (hereditary),
Reduced stomach acid, eg with long-term treatment with acid-reducing drugs,
Reduced pancreatic function,
Competition with vitamin B12 in the intestines by parasites or bacterial overgrowth (SIBO),
Malabsorption in the small intestine due to Crohn's disease, celiac disease, small bowel surgery or Imerslund-Gräsbeck syndrome.
Congenital errors in the transport or metabolism of vitamin B12:
Transport defect due to transcobalamin-II deficiency or cobalamin R-binding protein deficiency
Metabolic disorders.
Treatment of B12 Deficiency
Treatment depends on the cause of the deficiency. If the deficiency is mild and asymptomatic, a dietary adjustment or elimination of the underlying cause plus a good supplement may be sufficient. However, in most cases the cause cannot be eliminated and permanent treatment with vitamin B12 injections will be necessary.
In case of severe symptoms, immediate treatment with vitamin B12 injections is necessary to prevent permanent damage. Children with metabolic disorders and B12-binding protein deficiency often require high doses of vitamin B12 and additional forms of treatment.
Symptoms are of decisive importance during treatment. The effectiveness of the treatment cannot be measured by serum B12 levels after administration of the injections, because even if the transport proteins are fully saturated, this does not reflect how much B12 is actually present in the cells.
Although treatment can result in improvements in most patients, some permanent neurological damage may occur. The long-term course appears to be linked to the severity and duration of the deficiency, which clearly emphasizes the need for early diagnosis and adequate treatment.
