A child presents with growth retardation, inability to walk and bruises all over the body. Which of the following nutrients should be recommended as a supplement to the diet?

Appeared in: HP CHO -9 October 2022

Explanation

The triad of symptoms—growth retardation, inability to walk (pseudoparalysis), and widespread bruising—is the classic presentation of Scurvy.
Scurvy is caused by a severe deficiency of Vitamin C (ascorbic acid).
Vitamin C is crucial for collagen synthesis, which maintains the integrity of blood vessels and bone matrix.
Deficiency leads to fragile capillaries (causing bruises) and subperiosteal hemorrhages (causing extreme limb pain and refusal to walk).
Among the given options, citrus fruits are the richest and most direct source of Vitamin C needed to correct the deficiency.

Option A: Milk is a primary source of calcium and Vitamin D. Deficiency of these nutrients causes Rickets, characterized by bone deformities like bowed legs and rachitic rosary, not the hemorrhagic symptoms seen in this case.
Option B: Egg yolk is a good source of Vitamin D and Vitamin A. While important, it does not provide the Vitamin C needed to address capillary fragility and subperiosteal bleeding.
Option D: Pulses are an excellent source of protein and iron. Deficiency in these leads to protein-energy malnutrition (kwashiorkor/marasmus) and iron-deficiency anemia, which have different clinical presentations (e.g., edema, wasting, pallor).

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Nutritional deficiencies and their clinical manifestations in children, specifically Scurvy (Vitamin C deficiency) as background academic context rather than a clinical decision trigger.
Recognizing the classic triad of Scurvy is a critical diagnostic skill for nurses, especially in pediatric populations with feeding difficulties or restrictive diets.
A key nursing intervention is gentle handling. The pseudoparalysis is due to intense pain, and rough movement can cause further bleeding and distress.
Patient and family education about dietary sources of Vitamin C and proper food preparation (avoiding overcooking) is essential for treatment and prevention.

How to Approach the Question

First, analyze the cluster of symptoms presented in the question: growth retardation, inability to walk, and bruises.
Recognize that this specific combination of growth failure, skeletal pain, and bleeding tendency points towards a single underlying nutritional disorder.
Correlate each symptom to its pathophysiology. Bruising suggests a problem with blood vessel integrity. Inability to walk in a child suggests severe pain, likely in the bones or joints. This points to Vitamin C deficiency (Scurvy), which impairs collagen synthesis.
Next, evaluate the food options provided based on their primary nutrient content.
Milk is for Calcium/Vitamin D (Rickets). Egg yolk is for Vitamin D/A. Pulses are for Protein/Iron.
Identify that citrus fruits are the most well-known and richest source of Vitamin C.

Concept Tested & Keywords

Concept Tested: Nutritional deficiencies and their clinical manifestations in children, specifically Scurvy (Vitamin C deficiency).
Stem keywords: child, growth retardation, inability to walk, bruises
Lead-in keywords: which of the following
Clinical cues: The combination of skeletal issues (inability to walk), hemorrhagic signs (bruises), and growth failure points towards a specific systemic nutritional deficiency.

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 112-114

Practise the full HP CHO -9 October 2022

Attempt every question from this paper in a timed mock, then review the full solution for each one.