Multiple micronutrient deficiencies in a child fed an elemental formula

Children with developmental disabilities are at risk for malnutrition as a result of oropharyngeal dysphagia, interactions between nutrients and medications, altered energy and nutrient requirements, and their reliance on others to feed them. Several studies have documented alterations in weight and height parameters in these children (1). Recently, technologic advances such as percutaneous gastrostomy tube placement have significantly improved the nutritional status of many of these patients. In addition, a variety of proprietary formulas are being increasingly used to provide these patients with nutritional support. We describe a patient with developmental delay who received an elemental formula through a gastrostomy tube and who, despite normal energy balance and macronutrient status, developed signs and symptoms consistent with scurvy. He had severe vitamin C deficiency and deficiencies of vitamin A and zinc.