) deficiency was diagnosed in two children in Georgia. The children were breastfed by mothers who followed vegetarian diets*. This report summarizes the two cases and provides guidance for health-care providers on identifying and preventing cobalamin deficiency among breastfed infants of vegetarian mothers. Case 1 During August 2001, a girl aged 15 months was hospitalized for lethargy and failure to thrive. She was born after a full-term pregnancy complicated by prolonged nausea and vomiting. She was breastfed for 8 months, but the extent (exclusivity) of breast milk consumed relative to other food was unknown. Her mother reported following a vegan diet during the preceding 7 years and took nutritional and vitamin supplements. The cobalamin content of the supplements was unknown. When the child was aged approximately 8 months, organic whole-grain cereals and fruit shakes were introduced, but she had a poor appetite and vomited regularly. Her parents became concerned about her growth and development, and she was evaluated by a pediatrician at age 15 months. The pediatrician diagnosed failure to thrive, developmental delay, and severe macrocytic anemia. The child was hospitalized, and cobalamin deficiency was diagnosed (marked elevation [not quantified] of urine methylmalonic acid; serum
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