Use the table below to add up your child’s score and determine his/her risk of B12 deficiency.

Pediatric Cobalamin Deficiency Risk (PCDR) Score

  • Low Risk:                   0 to 1
  • At Risk:                      2 to 4
  • High Risk:                  5 or greater

  

I. Neurological Manifestations (+2)

  • Developmental delay or regression (motor, speech, language, or social)
  • Hypotonia
  • Poor suckling/swallowing
  • Abnormal movements
  • Ataxia
  • Tremors
  • Seizures
  • Paresthesias
  • Lhermitte’s sign
  • Romberg’s sign
  • Weakness of extremities
  • Clumsiness or falling
  • Dizziness
  • Visual disturbances
  • Impaired vibration, position sense
  • Mental status changes
  • Abnormal reflexes
  • Paralysis
  • Coma

II. Neuropsychiatric Manifestations (+2)

  • Depression or apathy
  • Suicidal ideations
  • Diagnosis of mental illness or on psychiatric medications
  • Anxiety
  • ADD/ADHD
  • Personality changes
  • Poor concentration or foggy thinking
  • Poor verbal fluency or problem solving
  • Low IQ
  • Paranoia
  • Mania
  • Hallucinations
  • Psychosis
  • Violent behavior or homicidal ideations

III. Hematologic Manifestations (+2)

  • Anemia
  • Macrocytosis
  • Hypersegmented neutrophils
  • Anisocytosis
  • Leukopenia
  • Thrombocytopenia
  • Pancytopenia

IV. General Signs/Symptoms (+1)

  • Abnormal head circumference or growth
  • Anorexia, poor feeding/appetite
  • Drowsiness or lethargy
  • Dyspnea
  • Failure to thrive
  • Frequent infections
  • Glossitis or stomatitis
  • Hepatomegaly or splenomegaly
  • Irritability
  • Orthostatic hypotension
  • Pallor or jaundice
  • Postural orthostatic tachycardia
  • Skin hyperpigmentation or hypopigmentation
  • Systolic flow murmur
  • Tinnitus
  • Chronic vomiting, diarrhea, or constipation
  • Weakness or fatigue
  • Weight loss, no weight gain, or weight <25th percentile

V. Gastrointestinal Risks (+2)

  • Malabsorption syndromes (e.g., Crohn’s disease, IBS, celiac disease, gluten sensitivity)
  • GERD
  • Gastroparesis
  • Helicobacter pylori infection
  • Giardiasis
  • Gastrectomy (partial or complete)
  • Ileal resection (partial or complete)
  • Small intestinal bacterial overgrowth
  • Pancreatitis, pancreatic exocrine insufficiency
  • Liver disease
  • Diphyllobothrium latum (fish tapeworm)

VI. (a) Population at Risk (+2)

  • Vegans, vegetarians, macrobiotic diets (mom or child)
  • MTHFR gene mutation
  • Nitrous oxide administration or abuse
  • Eating disorders

VI. (b) Population at Risk (+1)

  • Proton pump inhibitor or H2-blocker use
  • Metformin use
  • Breastfed children
  • Pregnancy (teens)
  • Family history of pernicious anemia
  • Autoimmune disorders
  • AIDS
  • Chemo- or radiation therapy
  • Low birth weight
  • Neural tube defects, cleft lip/palate, or congenital heart defect
  • Hydrocephalus
  • Phenylketonuria (PKU)
  • Down syndrome