Vitamin and mineral deficiencies in people with developmental disability

Patients with developmental disability may present with more severe vitamin and mineral deficiencies than the general population, due to communication impairment and delayed identification. Institutionalisation and undernutrition are risk factors for vitamin and mineral deficiencies; be aware of the common causes of being underweight and risk factors related to the person’s disability—test for specific nutrient deficiencies where clinically indicated.

People with developmental disability are especially at risk of folate and micronutrient deficiencies (eg vitamin C, vitamin D). Several case reports of scurvy, rickets or other vitamin deficiencies have been reported, particularly in children with autism and extreme food selectivity. Reduced sun exposure and some anticonvulsant medications can result in vitamin D deficiency. Vitamin and mineral deficiencies and their treatment (including information on vitamin D and calcium supplements) are discussed here.

Iron deficiency is common in people with developmental disability and can result from reflux oesophagitis; for assessment see Overview of iron deficiency.

For advice on recommended intake and sources of calcium, see Calcium and osteoporosis.

Food preferences (eg exclusions) may guide testing decisions; for dietary sources of key vitamins, minerals and trace elements, see Dietary sources of key vitamins, minerals and trace elements. If requesting a blood test or other investigation, consider other opportunistic tests that could be done at the same time (see also Opportunistic examinations and procedures for people with developmental disability).

For those with food selectivity, consider multidisciplinary management with desensitisation techniques (eg with occupational therapist, speech pathologist) and behavioural interventions (eg with behaviour clinician, psychologist), in addition to correcting specific deficiencies.