What is this?
Anemia occurs when the blood does not have enough red blood cells, which are the cells that carry oxygen from the lungs to all parts of the body. There are many different kinds of anemia; iron deficiency anemia (IDA) is the most common type in children. This happens when the body does not have enough iron in it to make red blood cells; for example, when a person does not eat foods rich in iron or bleeds too much for some reason.
According to current estimates from the World Health Organization, one-third of the world’s population (approximately 2 billion people, mostly from developing countries) may have anemia due to iron deficiency.
IDA can occur at any age, but most often it is seen in toddlers and adolescent females. Infants, toddlers and adolescents all have high iron needs because they are growing relatively fast compared with other times in their lives. While infants tend to get enough iron with breast milk and iron-fortified formula, toddlers often have diets with very little iron-rich foods. In addition, toddlers tend to drink too much cow’s milk, which itself is low in iron and makes it harder for the body to absorb iron from other foods in the diet. Adolescent females also tend not to eat as many iron-rich foods; also, they need extra iron to replace losses that happen with their monthly periods (menstruation).
Additionally, vegetarians may be more susceptible to IDA because the iron found in vegetables is less easily absorbed by the body than iron from red meat.
Symptoms of anemia may include:
- Pale skin, especially under the fingernails, inside the eyelids and around the gums
- Cracks at the sides of the mouth
- Difficulty exercising
- Shortness of breath
- Fast heart rate (tachycardia)
- Ringing in the ears (tinnitus)
- Poor attention span
- Poor growth
In younger children and infants, symptoms of anemia also may include:
- Poor appetite
- Wanting to eat things that are not usually eaten, such as dirt or ice
Although children with mild or moderate IDA tend to show few, if any symptoms, IDA in infancy and early childhood may cause developmental delays and behavior problems that may not go away even after the anemia is treated. Symptoms tend to appear only with long-lasting or severe anemia.
To know if there is IDA, the doctor will:
- Review your child’s medical history. There are some illnesses that increase the risk of IDA.
- Ask about your child’s diet. The doctor will want to know what kinds of iron-rich foods your child eats regularly, as well as whether your child takes any vitamins or supplements.
- Examine your child. The doctor will look for signs of IDA and try to figure out any possible cause.
- Check your child’s blood. Common blood tests for IDA include hematocrit and hemoglobin. Hematocrit (Hct) is the percentage of blood volume that is taken up by the red blood cells; hemoglobin (Hgb) directly measures the part of a red cell that actually carries the oxygen. An abnormally low Hgb or Hct (when compared with age-specific standards) combined with a diet low in iron makes IDA more likely. In a few cases, anemia may not be caused by low iron, and extra blood tests may be needed to make the correct diagnosis.
If your child does have iron deficiency anemia, the doctor will:
- Decide if your child needs to take extra iron and for how long. IDA usually is treated with iron supplements (most commonly ferrous sulfate) by mouth for several months.
- Recommend ways to increase the amount of iron in your child’s diet.
- Discuss the things you should watch for at home.
- Tell you when your child should be seen again. The doctor usually will want to check your child again to make sure that the anemia has gone away or at least is improving.
What can we do at home?
- If the doctor recommended extra iron by mouth, be sure your child takes it exactly as directed. Taking more than the recommended dose can be dangerous. Here is some other helpful information about iron:
- Iron is best absorbed when given between meals. However, in rare cases iron causes stomach (gastrointestinal) upset, which may be lessened when given with or right after meals.
- Vitamin C makes it easier for the body to absorb iron, but calcium makes it harder. Therefore, the extra iron should not be given with milk and it may work best when it is given with foods or drinks that are high in vitamin C such as fruits, vegetables and orange juice (calcium-fortified juice is OK).
- Iron that comes as a liquid may stain a child’s teeth temporarily, but these stains can be removed by brushing. You can avoid these stains by giving the iron with a dropper, squirting it into the back of the mouth, or through a straw.
- Always use iron-fortified formula for infants who are not being breast-fed.
- Do not give cow’s milk to your child before he is 1 year old because this tends to cause IDA due to bleeding from the intestine.
- Increase the amount of iron-rich foods in your child’s diet. There are two types of iron in the diet, heme and non-heme. Heme iron, found in the hemoglobin from animals, is taken into the body more easily than non-heme iron. Offer your child many iron-rich foods such as:
- Lean meats, poultry and fish
- Iron-fortified cereals, breads, pasta
- Dried fruits such as apricots, raisins or prunes
- Leafy green vegetables such as spinach, collard greens or kale
- Whole grains such as brown rice, wheat germ or bran muffins
- Beans, peas and nuts (not recommended for children under 3 years of age)
- Call the doctor if your child:
- Is not as active as you normally expect him to be
- Seems to be getting worse in any way
- Prevent iron-deficiency anemia by:
- Not giving your child any cow’s milk before his first birthday, as this tends to cause IDA due to losing blood from the intestine.
- Limiting the amount of milk your child drinks to no more than 24 ounces each day.
- Taking a multivitamin with iron, especially for adolescent females who have gotten their period.
Iron deficiency anemia is not contagious (spread from person to person). Therefore, children with IDA can go back to school or day care right away, as long as they feel well enough.