My daughter who is 14 is an ovo-lacto vegetarian and developed cracks in the corners of her mouth.

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My daughter who is 14, is an ovo-lacto vegetarian. I support this and between the two of us, we try to make sure she receives the nutrients she needs. She has been eating this way for about 4 months.

Recently she has developed cracks in the corners of her mouth. My older daughter had the same thing (same ovo-lacto diet), but they went away. My 14-year-old takes a multivitamin. I suspect there is some trace item she’s missing. She eats a variety of veggies, fruit, whole grains, legumes, rice, etc, as well as eggs, milk, and cheese. Any tips? Considering her age, any additional recommendations would be greatly appreciated!

Cracks in the corners of your mouth could indicate a riboflavin (vitamin B2) deficiency. But, since she is taking a multivitamin, I doubt riboflavin deficiency is the cause unless she is abusing alcohol. I suspect that she has an infection in her mouth which is easily treated.

Look inside your daughter’s mouth. Is her tongue coated white or the inside of her mouth coated white? These would be additional symptoms of a riboflavin deficiency. What other abnormalities do you see inside her mouth, on her tongue or gums? Is there a smell to the inside of her mouth?

Milk is a very good source of riboflavin and a multivitamin should contain 100% of the Recommended Dietary Allowances for riboflavin. The yellow-green tint in skim milk is caused by riboflavin. Light and irradiation destroy riboflavin though. Do you buy milk in containers that do not let in light? Riboflavin is not destroyed by heat and therefore is retained during cooking. Read the label on the vitamin bottle to determine the riboflavin level your daughter is taking.

Riboflavin deficiency may slow or stop your daughter’s growth. If the doctor suspects a riboflavin deficiency, then he can prescribe several times the RDA for riboflavin, but the doctor needs to check for other symptoms. A test for vitamin levels in the body may require collecting blood or a 24-hour urine collection. Not many labs in the US test body fluids for vitamin levels and it may take a while to get the results back. Instead, doctors usually prescribe several times the RDA for a specific vitamin, which is administered for several days to see if the symptoms go away. Would not suggest you play a doctor on this. Go make an appointment.

Riboflavin deficiency can occur because of alcoholism even when adequate amounts of riboflavin are present. This shouldn’t be discounted in even a 14-year-old.

If the cracks in the corners of her mouth are caused by an infection, she needs to be treated by a physician. I would recommend you make an appointment for her to see her doctor.

Once the cause is determined, I would suggest your daughter talk to a Registered Dietitian about a vegetarian diet. She may want to review the various beans, legumes, grains, fruits, and vegetables that a person even on a strict vegetarian diet (vegan) should eat to get the best-balanced variety of required vitamins and minerals. If your daughter is a lacto-ovo vegetarian, then she is also eating eggs and milk products in addition to the above foods.

BTW, her doctor may not suspect a riboflavin deficiency because traditional medicine has taught that vitamin deficiencies, other than iron, do not exist in the US because of an adequate food supply. Don’t be brushed off with this type of thinking. Also, if an antibiotic is prescribed and she doesn’t get better within a few days of taking a prescribed drug, go back to her doctor. Don’t subscribe to the thinking of wait and this will just go away.