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What is Anemia

Anemia refers to the state of low red blood cell count. The anemic person retains a normal total blood volume, unless the anemia is from acute blood loss.

Anemia is not a diagnosis; thus, if your child is anemic, her doctor should investigate the cause. In childhood, the most common cause of anemia is iron deficiency.

Causes  of anemia

  • nutritional ( low iron, low folate, low vitamin B12)
  • hemoglobin disorders (sickle cell disease, sickle cell trait, thalassemia–Cooley anemia, Thalassemia trait, others)
  • blood loss (from menses, gastrointestinal, others)
  • congenital anemias (Diamond-Blackfan syndrome, Fanconi’s anemia)
  • malignancy (leukemia, lymphoma, neuroblastoma)
  • lead poisoning
  • infections (viral, bacterial or parasitic infections)
  • side-effect of medications (antibiotics, others)

Iron deficiency is present in approximately 10% of children age 1-2 years and approximately 10% of adolescent females. Iron is a mineral that is essential in the formation of red blood cells. It is the red blood cells that carry oxygen throughout the body.

Newborn babies are born with adequate iron stores to last for the first 4 to 6 months of life. After this point, it is necessary to have iron in the diet to keep the body’s iron stores adequate. Formula contains a sufficient amount of iron to prevent iron deficiency. The iron in breast milk is very readily absorbed from the GI tract in infants, although the amount of iron is less compared to that in formula. Therefore, exclusively breast fed babies not started on iron-fortified cereals at 4 to 6 months of age should begin iron supplementation in the form of a liquid supplement.

Toddlers with poor solid intake and heavy milk consumption are also at risk for iron deficiency. Many toddlers will fill up on milk (some children drink a quart or more per day) and eat less solids. Milk is a very poor source of iron.

Many adolescent females have a diet which is marginal in iron content, and in addition have loss of blood monthly through menstruation. Therefore, adolescent girls should take a daily multi-vitamin that contains iron.

Symptoms of Anemia

The signs and symptoms of iron deficiency anemia include pallor (pale color to the skin), lethargy, irritability, and poor exercise tolerance. Iron deficiency is frequently associated with pagophagia, the desire to eat unusual substances such as ice or dirt. There have been reports suggesting that iron deficiency anemia can affect a child’s attention span, alertness and learning. Severe anemia can result in an increase in heart rate and enlargement of the heart.

The cornerstone of treatment is replacement of iron. This is done with liquid or tablet iron preparations prescribed by your child’s doctor. Therapy is usually continued for 8 weeks after the blood count has returned to normal. The length of therapy is 3 months in most cases. If possible, you should give the iron supplement with a source of vitamin C, such as orange juice, because vitamin C aids in the absorption of iron. Side effects of iron therapy include staining of the teeth and a change in the color of the stool to a greenish-black. If your child’s teeth appear stained, you can brush them with baking soda.

In addition to iron replacement by supplements, dietary changes should also be instituted. Your child should not drink more than 2 to 3 cups of milk per day. The following foods contain iron:

  • meats, fish, chicken
  • dried fruits, sweet potatoes, beans (lima, chili, pinto), green peas
  • peanut butter
  • enriched cereals and breadsRemember that too much iron can be dangerous. Keep iron and all other medications out of the reach of your children.