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What is Anemia

What is Anemia

Anemia” literally means “not enough blood.” Most doctors and parents mean “not enough red blood cells” when they speak of anemia, however. There are many causes of anemia in children. Iron deficiency, which means not having enough iron in the body, is the most common cause of anemia in the world. Children can get iron deficiency in one of two ways: not enough iron in the diet, or loss of iron from the body. During periods of rapid growth, many children experience both of these factors. This explains why iron deficiency is most common in toddlers and teenagers. Both groups are growing fast so they need more iron. Both groups have their own ideas about what they will and won’t eat, so they may not get enough iron in their diets. Toddlers often drink large amounts of cow’s milk. Drinking too much cow’s milk can cause blood loss through the intestines. Teen girls lose blood as they begin to menstruate.

The body uses iron in almost every tissue and organ, not just in blood. In fact, some of the more serious consequences of iron deficiency result from lack of iron in tissue such as brain, muscle, and bone. This is why it is so important to provide enough iron to children, especially during their periods of high need.

What is the biggest concern?

Children who don’t have enough red blood cells can’t deliver oxygen to their tissues normally. This means that their hearts and lungs have to work harder to keep up with demand. In the long run this can cause heart and lung problems. The growing tissue that depends on oxygen also suffers. In severe cases of iron deficiency anemia, children grow and develop more slowly. In the very worst cases, children become stunted and can suffer from mental retardation. Fortunately, this is very rare and we can prevent it by treating the anemia in time.

Children with less severe anemia may appear pale and they may tire easily. They may sleep more and not play as vigorously. Most often though, children with mild iron deficiency anemia look and act normal. They can have subtle problems like poor attention or learning that can interfere with normal development. This is why doctors do regular checkups and lab tests, especially during the times of rapid growth. Your doctor probably tested your child’s blood and determined his or her “hematocrit” or “hemoglobin” level. These are measures of the amount of red blood cells and iron-carrying proteins in the blood. Anemia is present when these levels are too low. Doctors sometimes do other tests to find the specific cause of the anemia. Because iron deficiency is the most common cause of anemia, many doctors will simply start iron supplements first. If the child’s red blood cell levels do not improve within a few months, they will then do other tests. Of course, if your child has severe anemia or other signs and symptoms, your doctor will do other tests right away.

Anemia treatment

The good news is that it is easy to treat mild to moderate iron deficiency anemia. A diet rich in iron-containing foods is important and can help prevent iron deficiency. Once a child is actually iron deficient, however, s/he needs more iron than s/he can get from diet alone. Even regularmulti-vitamins with iron are not enough to restore iron levels to normal. Doctors provide iron supplements to children with iron deficiency anemia. Your doctor will decide on the proper dose and form of iron supplement for your child. Iron supplements come as liquid and chewable tablets in the US. Many children complain of a bitter or metallic taste with iron supplements. You can help to hide this taste by mixing the iron into a small amount of juice or cereal. The vitamin C in juice also helps to speed iron absorption. At the same time, please avoid serving coffee or tea at meals or around the time your child takes the iron. These drinks interfere with iron absorption. Liquid or chewable iron supplements can stain teeth. Please have your child brush his or her teeth right after taking the dose if possible. If not, at least have him or her rinse the mouth or eat some other food to reduce the risk of staining. Canadian researchers have recently developed a new form of iron and other nutrient supplement called “Supplefer Sprinkles.” You may want to check with your doctor to see if they are available. Most iron supplements cause mild to moderate constipation, so it is a good idea to work on increasing the amount of fiber in your child’s diet. You can also read our article on Constipation.

Your doctor will test your child’s blood again in a few months if the anemia wasn’t too severe, sooner if it was. Once the iron and blood levels return to normal, your doctor may recommend that you continue the supplement at a lower dose. S/he will definitely recommend that you try to provide an iron-rich diet for your child. Many different foods contain iron. Meat and poultry can be the best sources because people can absorb the iron in those foods more easily than from fruits and vegetables. Even vegetarians, though, can get enough iron from their diets by consuming a good variety of foods. It is also important to limit the amount of cow’s milk your toddler drinks. The protein in cow’s milk can irritate intestines and cause them to lose small amounts of blood. Toddlers and young children should not drink more than 16 to 24 ounces (470 to 710 ml) of cow’s milk per day.

Here is a table of foods that contain iron in easily absorbed forms. You might want to post this on your refrigerator or near where you make your menu plans and shopping lists. Have your older child or teenager participate in meal planning and shopping, so that s/he feels included in the process. S/he will be more likely to actually eat these foods if you do that.

Iron Rich Foods

  • Red meat
  • Dark poultry
  • Tuna
  • Salmon
  • Eggs
  • Tofu
  • Enriched grains
  • Dried beans and peas
  • Dried fruits
  • Leafy green vegetables
  • Blackstrap molasses
  • Iron-fortified breakfast cereals

Although it is smart to avoid processed foods in general, many foods such as breads and cereals come in iron-fortified forms. These can be excellent sources of iron for picky toddlers.

When should I be worried?

Iron deficiency anemia clears up slowly over about 3 to 6 months with proper supplements. If your child had symptoms such as tiredness or paleness, you should see improvement before that much time – generally within a few weeks. Sometimes, iron deficiency comes from a cause other than dietary lack, such as hidden bleeding or a problem with absorption of iron. Also, there are many other forms of anemia that won’t improve with iron supplementation. Here are a few things to look out for that might suggest that something else is going on:

  • Worsening paleness or low energy levels
  • A persistent or worsening cough
  • Swelling of legs and feet
  • Yellowish color of the skin or eyes (jaundice)
  • Dark brown or red colored urine
  • Black or tar-colored stools
  • Abdominal pain or swelling
  • Headache, dizziness, or light-headedness

If any of these occur, please be sure to call your doctor’s office right away.


Other points of concern

Severe iron deficiency can cause a condition called “pica,” in which children eat non-food items such as dirt, paint, and other things. If children eat things that contain lead (such as paint flakes in many older houses, and soil in some areas), they can develop lead poisoning. Iron deficiency actually increases the speed of lead absorption into the body, so children with anemia are at very high risk. If you see signs of pica in your child, please talk to your doctor right away.

In unusual cases, children can have other conditions that interfere with iron absorption, or increase iron losses through urine or stool. These include inflammatory bowel diseases likeCrohn’s Disease or ulcerative colitis, and some infections. If your child has blood in the stool or urine, please see your doctor right away.

Very Important Warning: Although iron supplements are very important for children who are iron deficient, they can also be extremely dangerous if someone takes too much. Please be sure to give only the amount of iron supplement that your doctor prescribes, and do not increase the dose without checking with your doctor. Please keep all iron-containing medications (remember the left-over maternal iron pills!) in child-proof containers and out of children’s reach. Iron overdoses are often fatal. Signs of overdose are sudden vomiting,abdominal pain, and dark or bloody diarrhea. If any person who lives in a house where there is iron-containing medicine develops these symptoms, please have them see a doctor right away.


Other Conditions that Might Be Present with Anemia

Although iron deficiency is the main cause of anemia in children, there can be other causes.Sickle cell anemia is a condition in which red blood cells take on unusual shapes that don’t flow smoothly through blood vessels. Most people with sickle cell anemia know about it because all US states screen for it at birth. Sickle cell anemia causes severe pain and many other complications. “Spherocytosis” (sphere-oh-sigh-toe-siss), is another inherited form of anemia. Red blood cells get trapped in the spleen and can cause it to swell. The treatment is removal of the spleen. Thalassemia (thall-ah-seem-ee-ah) is another condition that causes the spleen to destroy red blood cells. It is common in people from the Mediterranean region and the Middle East. Children with a condition called “G-6-PD deficiency” and a few other rare conditions can experience a sudden breakdown of red blood cells. People with G-6-PD deficiency must avoid aspirin, sulfa drugs, and certain other chemicals and foods that can trigger red cell breakdown. If your child’s anemia does not respond to iron treatments, or if his or her symptoms suggest any of these conditions, your doctor will test for them.