What is the primary treatment for a child diagnosed with scurvy?

Treatment of Scurvy in Children

For children diagnosed with scurvy, immediately initiate oral vitamin C at 15-25 mg/kg/day for infants up to 12 months or 80 mg/day for older children, continuing treatment for at least one month until clinical symptoms resolve. 1

Immediate Treatment Protocol

Do not delay treatment while awaiting laboratory confirmation if clinical features are present—diagnosis should be made clinically based on characteristic symptoms such as perifollicular hemorrhages, mucocutaneous bleeding, refusal to walk, or gingival swelling. 1, 2

Dosing by Age

• Infants up to 12 months: 15-25 mg/kg/day orally 1, 2
• Children over 12 months: 80 mg/day orally 1
• Alternative adult-derived regimen for older children: 100 mg three times daily (300 mg/day total) for at least one month 2

Route of Administration

• Oral administration is standard for uncomplicated scurvy 2
• Parenteral (IM, IV, or subcutaneous) routes should be reserved for cases where oral administration is not possible, insufficient, or contraindicated, or when malabsorption is suspected 2, 3
• Intravenous ASCOR is FDA-approved for short-term treatment (up to 1 week) in pediatric patients 5 months and older when oral administration cannot be used 3

Expected Clinical Response

Dramatic clinical improvement typically occurs within 48 hours of initiating vitamin C supplementation, with resolution of pain, refusal to walk, and other musculoskeletal symptoms 4, 5. Complete symptom resolution generally occurs within the one-month treatment period 1.

Long-Term Management After Acute Treatment

Maintenance Dosing for High-Risk Children

• Children with chronic restrictive diets (autism spectrum disorder, developmental delays, oral aversion) require 200-500 mg/day indefinitely to prevent recurrence 1, 2
• Healthy children require only 75-90 mg/day, achievable through diet alone 1

Dietary Counseling

Parents must understand that formula and human milk contain adequate vitamin C, but exclusive cow's milk feeding without supplementation places older infants at high risk for scurvy, particularly with ultra-heat temperature (UHT) processed milk 1, 6

Critical Safety Considerations

Absolute Contraindications to High-Dose Vitamin C

• Hemochromatosis or iron overload conditions 1, 2
• G6PD deficiency 1, 2
• History of oxalate kidney stones 1, 2
• Severe renal dysfunction without dialysis support 1, 2

Special Precautions in Young Children

Pediatric patients under 2 years are at higher risk of oxalate nephropathy due to age-related decreased glomerular filtration 1, 3. However, this risk must be weighed against the life-threatening nature of untreated scurvy—treatment should not be withheld but monitored carefully.

Children with kidney disease (CKD stages 1-4) should not exceed 100 mg/day to prevent oxalate accumulation 1

Common Clinical Pitfalls to Avoid

Diagnostic Delays

Scurvy is increasingly common in children with autism spectrum disorder, developmental delays, and restrictive eating patterns—a simple dietary history often reveals the diagnosis and avoids costly, elaborate diagnostic workups 7, 8, 9. The condition is more contemporary than historically thought 9.

Laboratory Testing Pitfalls

• Plasma vitamin C levels are unreliable when CRP >10 mg/L, and normal values are not detected if CRP >40 mg/L 1, 2
• Do not measure vitamin C levels in acutely ill or inflamed patients, as results will be falsely low and misleading 2
• Testing should only be ordered for suspected scurvy or chronic low intake, not routinely 1

Radiographic Confusion

Metaphyseal changes in scurvy can resemble classic metaphyseal lesions (CMLs) seen in child abuse, but scurvy shows additional distinguishing features including osteopenia, dense epiphyseal rings (Wimberger sign), and extensive calcification of subperiosteal hemorrhages 6. Characteristic findings also include increased sclerosis of zones of provisional calcification and metaphyseal irregularity 1, 6.

Treatment Adherence Challenges

Oral supplementation may pose unique challenges in children with autism spectrum disorder and oral aversion 8—consider liquid formulations or, if necessary, short-term parenteral administration followed by transition to oral therapy once symptoms improve 2, 3.