You might associate scurvy with sailors of times gone by, but while our knowledge of exactly what causes it and how to get rid of it has meant that it’s rare in today’s world, it’s still not a disease of the past. As evidence of this, an unusual case report has surfaced in which an infant developed scurvy after being given a vitamin C-devoid diet almost entirely based on almond milk.

Likely the result of healthy food trends combined with environmental concerns, plant-based drinks have boomed in popularity in recent years, in particular in the Western world. From soy milk to hazelnut and rice drinks, shelves see no shortage of dairy-free alternatives. And while that’s not exactly a bad thing, this latest report highlights the need for parents to take into consideration the nutritional content when choosing a diet for their infants, namely the lack of vitamin C.

Described in the journal Pediatrics, the case involves an infant who was presented to doctors in Spain at 11 months old with tiredness, irritability, and a failure to thrive. Going through the child’s history, he was fully vaccinated, never breastfed, and for the first two-and-a-half months of his life he was given a cow’s milk-based formula.

After developing a skin condition at this age, his doctor recommended that his daily diet be changed to a prepared mixture consisting of almond milk, almond flour, a mix of cereals and sesame powder, alongside probiotics. The mother tried to feed the child mashed up fruit and vegetables in addition, but with no success. Alongside a whole host of other important substances and minerals, these foods are laden in vitamin C, something our body can’t make itself and thus must get from external sources. Unfortunately for the child, his almond-based formula didn’t contain vitamin C.

Vitamin C is easily obtained through a proper diet. Milleflore images/Shutterstock.

The infant appeared to be doing fine on this diet at the start, but at eight months his stability while sitting decreased and he became less interested in interactions with others. By 11 months of age, he refused to support his legs on a hard surface and cried if anyone attempted to move his lower limbs. Upon further examination, his bones showed a lower mineral density than normal and his femur, alongside several vertebrae, was fractured.

Blood tests soon gave up the problem: He was severely deficient in vitamin C, alongside vitamin D, and so was given the diagnosis of scurvy. The child’s almond-based mixture was quickly abandoned and replaced with a new diet consisting of vitamins C and D supplements, formula, cereals, meat, fruit, and vegetables. Within a month and a half, his fractures had improved and his vitamin C and D levels were normal. Two weeks later, he started walking.

Vitamin C is incredibly important for the body, playing a role in the synthesis of collagen – our most abundant protein that quite literally holds the body together – and neurotransmitters. Since we can’t produce it, we need to make sure our diet contains enough – oranges, strawberries, and kiwis contain loads, among various other foods. While almond milk isn’t bad for infants, its industrial processing destroys vitamin C, so it’s important to feed infants foods like these alongside such formulas to ensure deficiencies don’t arise. As such, the authors conclude that plant-based beverages should never serve as a complete replacement for infant formula or breastfeeding.