Vitamin A Deficiency in Children | Symptoms | Sources | Prevention | Effects ||Diagnosis | Management

Vitamin A deficiency is the leading cause of death and disease in children under the age of five in developed countries. The prevalence of clinical signs of vitamin A deficiency in preschool children in developed countries is almost 0.6%.

Of the 3.3 million affected children, 2 million are in Asia.

The risk of death from vitamin A deficiency increases. Its presence appears much earlier in ocular symptoms and spreads much more from clinical vitamin A deficiency.

It is important to provide rich sources of vitamin A in the diet. The Government/UNICEF of Pakistan has adopted a strategy to provide doses of vitamin A. It involves taking capsules (drops) twice a month of vitamin A. Ideally, vitamin A should be given every six months.

Daily Requirement:

The daily requirement is 1500 IU/day.

Sources:

Precursors of vitamin A (carotenes) are found in the yellow and green parts of plants, especially in abundance in carrots.

The active vitamin is synthesized in the intestinal mucosa by hydrolysis of beta-carotene. Each molecule can produce two molecules of vitamin A, which are absorbed as retinol esters and stored in the liver. Retinol is transported to tissues bound to alpha-globulin, a retinol-binding protein.

Vitamin A is also present in dairy products and eggs.

Breast milk and whole cow's milk are important sources of vitamin A.

Function:

Vitamin A acts on various areas in the human body and enables certain processes:

- Maintaining the integrity of epithelial surfaces

- Ensuring the presence and operation of the visual system

- Strengthening the immune system

- Ensuring standard growth and development

- Help in the efficient use of iron for the formation of hemoglobin

- Synthesis of mucopolysaccharides

- Excretion of mucus

Moderate vitamin A deficiency, potentially related to hematologic problems, may be a complex cause.

Zinc deficiency can lead to immobilization of liver stores of vitamin A.

Effects of vitamin A deficiency:

1. Impaired adaptation to the dark, leading later to night blindness

2. Xerosis of the conjunctiva and cornea (dryness)

3. Bitot's spots (dry silver-gray plaques on the bulbar conjunctiva)

4. Keratomalacia (wrinkling of the cornea and cloudiness)

5. Follicular hyperkeratosis

6. Photophobia

7. Xerosis (dryness) of the skin, keratosis (excessive keratinization of the skin)

8. Recurrent diarrhea and respiratory infections (due to delayed epithelialization)

9. Slowing down of mental and physical growth

10. Apathy

11. Anemia

12. Increased frequency and severity of infections

13. Rarely increased intracranial pressure and hydrocephalus

Diagnosis:

Dietary research can help identify vitamin A deficiency.

Clinical evaluation (skin, eyes, growth). Ocular symptoms are crucial for the clinical evaluation of vitamin A deficiency. These symptoms appear when blood retinol levels are below 0.35 µmol/L.

Dark adaptation test

Biomicroscopic examination of the conjunctiva or chest scraping

Plasma carotene concentrations or vitamin A (retinol) levels. Even a slight decrease in serum retinol indicates depletion of vitamin A stores. Serum retinol levels range from 0.35 µmol/L to 0.70 µmol/L.

Prevention:

Daily supplementation of 1500 IU of vitamin A.

Breastfeeding protection and support

Vitamin A supplementation for high-risk groups

Nutrition guarantee, diet improvement

Prevention of infections, especially in measles and the gastrointestinal tract and mucous membranes

Management:

Children with severe protein energy malnutrition (PEM), recurrent or persistent gastroenteritis and measles should receive a single dose of 200,000 IU of vitamin A. Infants aged 6-12 months receive half the dose (WHO recommendation). Infants under 6 months do not require routine dosing, but 50,000 IU of vitamin A is given for measles. If the child shows signs and symptoms of deficiency, he should receive 200,000 IU (100,000 IU under 1 year) on days 1, 3, and 14 .

Foods rich in vitamin A should be given in abundance to at-risk or clinically deficient children.