VITAMIN B12 DEFICIENCY IN PAEDIATRIC NEUROLOGY

What are the sources of Vitamin B12 ?

Vegetarian diets are deficient in Vitamin B12 as plants neither produce or require B12. Organic fertilizers such as cow manure appear to slightly increase the B12 content of spinach leaves (approximately 0.14 μg/100 g fresh weight). Some blue green algae and seaweeds may contain vitamin B12 but they are not consumed in Indian diets .Milk, paneer , yoghurt are good sources of Vitamin B12. 

Other wise it is found in non-vegetarian foods like. eggs , meat and fish.

How is Vitamin B12 used in the human body?

Vitamin B12 is important in the pathway of breaking down fats and amino acids for energy. It keeps the nerves healthy and is important to produce healthy red blood cells.

What can happen if there is vitamin B12 deficiency?

 Deficiency of Vitamin B12 usually causes anaemia in adults and a wide variety of neurological symptoms and other symptoms  in children.

What kind of symptoms can a child or young person have when they have Vitamin B12 deficiency ?

Children and adolescents may have a wide variety of symptoms including 

• Weakness, tiredness. 
• Lightheadedness, dizziness and sometimes fainting episodes.
• Rapid heartbeat and breathing.
• Gastric upset, weight loss, diarrhea or constipation. 
• Muscle weakness and tingling in the extremities, problems with walking , poor vision, rarely fits/seizures
• Memory problems , difficulty paying attention in class and behavioral problems.

• In infants of mothers who have Vitamin B12 deficiency , they may have poor activity , developmental delay, anemia and tremors. They may have increased pigmentation ( darkening ) of the backs of the hands. This in medical terms is called as Infantile Tremor Syndrome ( ITS) /Neurocutaneous Syndrome of Vitamin B12 deficiency.(NIB syndrome) 

How is VitaminB12 deficiency treated ?

Usually injection Vitamin B12 is required , though sometimes oral or sublingual may be given. Discuss with your doctor the best way to treat your child/young person.

References :

1. Watanabe F, Bito T. Vitamin B12 sources and microbial interaction. Exp Biol Med (Maywood). 2018 Jan;243(2):148-158. doi: 10.1177/1535370217746612. Epub 2017 Dec 7. PMID: 29216732; PMCID: PMC5788147.
2. Bhagwat C, Sankhyan N. Vitamin responsive conditions in pediatric neurology. Karnataka Paediatr J 2021;36(1):42-8.
3. Serin HM, Arslan EA. Neurological symptoms of vitamin B12 deficiency: analysis of pediatric patients. Acta Clin Croat. 2019 Jun;58(2):295-302. doi: 10.20471/acc.2019.58.02.13. PMID: 31819326; PMCID: PMC6884369.

Dr Rashmi Adiga, 

MBBS, DCH, MRCPCH(U.K), CCT(U.K), FRCPCH.

Consultant Paediatric Neurologist