ZINC DEFICIENCY IN CHILDREN

What is the function of zinc in children?
Zinc is a trace element that is essential for normal growth and development of infants and children. Zinc is a constituent of more than 100 enzymes in the body.

Which organs are in the body have high stores of zinc?
High levels of zinc are found in choroid of the eyes, prostrate, kidneys, liver, muscles and bones.

Which food items are good stores of zinc?
Meat, eggs, nuts, cheese, oysters and grains are good sources of zinc. Cereal diets rich in phytates decrease the absorption of zinc by binding to zinc.

What is the daily requirement of zinc?
The recommended daily allowance of zinc is 5mg in infants, 10mg in children 1-10 years of age and 15mg in children >11 years of age. Nursing and pregnancy increases zinc needs due to increased requirements.

In which conditions can zinc deficiency occur?
Zinc deficiency is more common in people in developing countries who eat a high phytate diet. Vegetarians are also prone to zinc deficiency. Zinc absorption takes place in the intestine and thus malabsorption, cirrhosis of liver, celiac disease, Crohn's disease and chronic diarrhea can all lead to zinc deficiency. Too much supplementary iron can interfere with zinc absorption.

What are the symptoms of zinc deficiency?
Because zinc is required for many functions in the body, deficiency of zinc can lead to a wide variety of symptoms and clinical manifestations. Zinc deficiency is predominantly seen in patients with malabsorption, poor dietary intake, pregnancy, lactation, preterms children with pica and elderly individuals. Mild zinc deficiency can lead to poor appetite and weight loss with increased susceptibility to infections. Patients can have altered taste and smell. Moderate to severe zinc deficiency can lead to growth failure, delayed healing of wounds, short stature, acrodermatitis enteropathica and hair loss. Zinc deficiency in the pregnant woman can lead to poor growth in the fetus.

What is Acrodermatitis enteropathica?
It is a genetic disorder characterized by failure of to absorb zinc from the diet in the body. It leads to growth failure, allergic skin lesions, diarrhea and poor appetite and alopecia. Daily zinc supplementation (20-40 mg/day) results in recovery. Untreated, it progresses to severe malnutrition and causes recurrent intercurrent infections.

How is the diagnosis of zinc deficiency made?
Diagnosis of zinc deficiency can be established by estimating blood zinc level.

What is the role of zinc in diarrhea?
Based on studies in India and other developing countries, zinc is recommended in the treatment of acute diarrhea. Zinc helps to reduce quantity of stool and the duration of diarrhea. A uniform dose of 20 mg of elemental zinc is given during the period of diarrhea and for 7 days after cessation of diarrhea to children older than 3 months.

What happens when excess quantity of zinc is taken in the diet?
Excessive intake of zinc (100 mg to 300 mg/day) can lead to toxicity. Zinc supplement in amounts of 2 gm/day can lead to nausea, vomiting, abdominal pain, diarrhea, convulsions. Chronic high dose zinc ingestion leads to lethargy, anemia, and neurological side effects predominantly due to lowering of copper levels.

In which diseases, zinc treatment is required?
Currently zinc is recommended as an additional therapy in severe malnutrition and chronic diarrhea. It is also used in treatment of Wilson's disease. Wilson's disease is a genetic disorder due to which excess copper deposits in the body. This excess copper causes liver or brain damage. Zinc blocks the absorption of copper in these conditions.
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