Veganism is spreading in western societies, as a new healthy and ecological diet. But in children, it can lead to malnutrition, with damaging consequences in a still-developing organism. We report the case of a thirteen-month-old boy born at term with appropriate measurements and no medical history. He was kept at home by his mother, and his father was a senior executive. He was brought to the Hospital because of hypotonia and loss of walking ability. He didnt babble, had difficulties to hold sited, presented with lanugo and ulnar metaphysis dilation. At examination he presented with growth and weight failure, but curves were not available since he lacked medical follow-up. His body measurements were 7.3 kg (−3 DS), 71 cm (−2 DS), IMC 14.5 kg/m2 (−2.2 DS). He had no vaccination and had not received D vitamin complements. The parents reported that he was breastfed his first six months, then they introduced a vegan diet with home-made rice milk. Biological investigations revealed hypocalcaemia (calcium 2.21 mmol/l) with hypophosphatemia (phosphorus 0.6 mmol/l); elevated alkaline phosphatases (1066 U/l (Normal Values (NV)<35)); elevated PTH (21.2 pmol/l (NV0.85.2)); Vitamin D deficiency (25OH-Cholecalciferol 17.8 nmol/l (NV75250)). He also has a low pre-albuminemia (2.0 μmol/l (NV2.76.4)), and deficiencies in vitamin A (0.6 μmol/l (NV0.71.5 μmol/l)), vitamine B6 (6.8 nmol/l (NV20134)), vitamin C (15.9 μmol/l (NV2885)), and iron deficiency anaemia (Haemoglobin 9.8 g/dl, iron 7 μmol/l (NV1124)). Whole body X-rays showed bilateral diaphysis fractures on fibula and ulna, rickets features (diffuse osteopenia aspect, ribcage bumps, cupula deformation of metaphysis).
Management: The boy was placed in a care facility where he received supplementations (25OHvitD3 100.000UI/month, oral calcium 500mg/day, oral iron and vitamins) and progressive dietary diversification. Treatment permitted a marked increase in his psychomotor development and restoration of walking ability. His muscle tone improved and he restarted smiling and babbling. He gained weight and recovered a normal growth velocity. His abnormal lab-test got progressively normal. He went back home after three months and acceptation of this new diet by the parents.
Conclusion: We reported here severe rickets associated with several fractures and nutritional deficiencies responsible for developmental regression and growth retardation, in a child under vegan-diet. The long-term consequences of such prolonged and severe deficiencies are unclear and developmental retardation may persist in this child. It appears crucial for health professional to ask for diet inhabits and to detect possible deficiencies, even in wealthy families, in order to prevent the damaging consequences of restrictive diet on childrens development.
18 - 21 May 2019
European Society of Endocrinology