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Part 4: Keeping Your Child Healthy  >  The A-Z of Childhood Illnesses  >  Anaemia


Anaemia is quite common in infants as well as older children. Keep this possibility in mind if you notice a sudden change in the behaviour of your child or if he starts falling ill too frequently.

Iron-Deficiency Anaemia
Although there are other types of anaemia, iron deficiency is the commonest cause, and is common even in children from well-to-do families.

SYMPTOMS: Mild iron-deficiency anaemia may not produce any obvious symptom. But anaemia, if untreated, makes a child irritable, causes loss of appetite, tiredness, starts making him inattentive at school, and prone to recurrent infections. The child’s school performance may suffer. Treatment with iron may dramatically improve his behaviour and general condition. Some of the causes of brain strokes may also be associated with iron deficiency. It is reported that between 10% and 12% of strokes in children can be explained by the presence of iron deficiency. 

Iron-deficiency anaemia is common between the ages of 9 to 24 months, and is evident in most children around their first birthday. Children given animal milk are likely candidates even at an earlier age. Anaemia should be suspected in older children, including adolescents, if you notice the symptoms mentioned earlier.

It must, however, be stressed that these symptoms may also be due to other causes. For instance, your child who is ‘not eating well’ may want to feed himself or may be rebelling just because he is being forced to eat. A child behaving oddly may have unfavourable circumstances at home or at school. 

After anaemia is suspected, look at the colour of the skin, the conjunctiva of the eye, the tongue and the nails for pallor.

Unfortunately, the pallor in the skin and mucous membrane may become evident only when the haemoglobin falls well below the normal (11 gms or more). Again remember that a pale-looking skin is a common feature in children who are fair and are kept mostly indoors.

TREATMENT: As iron deficiency is the commonest cause of anaemia, doctors often ask for CBC (Complete Blood Count) only to diagnose it. The haemoglobin of such patients is lower than normal and the red cells are found to be hypochromic (pale looking) and microcytic (smaller than the normal size). The mean haemoglobin between 6 months and 6 years is 12g/dl (with a normal range of 10.5-14) and between 7 and 12 years, it is 13 g/dl, with a normal range of 11 to 16. The patient is given oral iron in adequate dosage and the blood test is repeated after completion of the course. The blood picture should return to normal. If not, we conclude that either the child was not given the medicine regularly or the diagnosis needs to be reconsidered. The diagnosis of iron deficiency can be confirmed by doing some further tests.

The total amount of iron is to be divided in 2 to 3 doses per day and given in between meals. The medicine must be continued for 2 months after the haemoglobin level returns to normal. Milk hinders the absorption of iron with meals. Cereals can also interfere with the absorption of iron. However, Vitamin C helps in the absorption, so give your child a citrus fruit or fruit juice after the medication.

Iron can temporarily stain the teeth a greyish-black. Place the medicine on the tongue and give the child a little water after the dose. If possible, brush his teeth after each dose. Since some iron is excreted with the stools, they may also be dark in colour.

Some amount of constipation or 2 or 3 somewhat loose motions in a child treated with iron can be ignored. A small percentage of children may get severe constipation with iron. One may try reducing the dose a little (say 7.5 ml per day in place of 10 ml) or try another iron preparation. It must be added that any preparation can cause a bowel upset in an individual patient. However, while a particular patient may not tolerate a certain preparation, he may accept another without any side effects.

Children who do not tolerate oral iron or those whom doctors cannot follow to make sure that the drug is given regularly — like children going out of town — are sometimes given injections of iron. 

PREVENTION: Apart from exclusively breastfeeding the child for 6 months, and continuing breastfeeding into the second year, fruits, vegetables and homemade soft foods should be added to the child’s diet at 6 months of age. Food items that should be specially kept in mind are leafy, green and yellow vegetables, fruits, ragi (nachni), tomatoes, raisins, red beans and unpeeled potatoes. Nonvegetarians can include meat, liver, egg and fish in the diet. Babies born prematurely are given iron in medicinal form from the age of 6 weeks.

In a study from Ethiopia, lower rates of anaemia and better growth were found in children fed food from iron pots than in children where food was cooked in aluminium pots. This is a simple and practical method to prevent iron deficiency. 

Anaemia Due To Goat’s Milk

Goat’s milk is deficient in folic acid. This deficiency can also result in anaemia.

TREATMENT: These children need folic acid. Quite a few medicines containing iron also have folic acid added.

Pica (eating mud, wall scrapings, paper, etc.) can also interfere with absorption of iron.

TREATMENT: Oral iron and deworming.

Hookworm Anaemia
Hookworms, acquired while walking barefoot on a field contaminated with the ova and larvae of hookworms, can also cause anaemia. The larvae hatch and penetrate the skin of the feet. Adult hookworms hook themselves to the upper intestines and suck blood. The eggs of the worms are excreted in the stools. 

TREATMENT: People infected with hookworms should be instructed not to walk barefoot and should be treated for eradicating hookworms from the system. Very often, these people have iron deficiency and need treatment for the same.

Other Causes Of Anaemia
Though rare, certain other causes of anaemia should also be kept in mind: Anaemia in a newborn due to blood group incompatibility (see Jaundice), excessive bleeding at any age; infections, certain drugs, and serious diseases like leukaemia (see Cancer).

A serious type of anaemia due to Vitamin B12 deficiency can occur in breastfed babies whose mothers are on a strict vegan diet (see section on diet in the chapter on PREGNANCY).

G-6-PD Deficiency

A passing reference may be made to a type of anaemia that may occur due to excessive breakdown of red blood cells deficient in an enzyme called G-6-PD. Its deficiency is seen in about 5% of the Indian population. It is more common in communities like the Parsis, Sindhis, Punjabis, Bhanushalis and Lohanas. If severe, the condition can present soon after birth or may appear later due to toxic effects of drugs on these G-6-PD deficient red cells.

MANAGEMENT: A simple test is carried out to detect this deficiency. Children with this diagnosis should avoid drugs like paracetamol, sulpha, certain anti-malarials like primaquine, nitrofurantoin and furazolidone (prescribed for urinary infection and gastro-intestinal infections respectively), the water-soluble form of Vitamin K and chloramphenicol.

Conditions That Can Be Confused With Iron-Deficiency Anaemia
An iron-deficiency type of picture can also sometimes be seen in children with ‘lead poisoning’ secondary to application of surma to the eyes and in children with pica mentioned earlier. Surma may contain high levels of lead. In market samples studied in Mumbai, it was found that most had high levels of lead varying from 20% to 80%.

While discussing iron-deficiency anaemia, we should familiarise ourselves with a condition called ‘Thalassemia minor’. Children with this condition also have microcytic, hypochromic type of anaemia. In absence of iron deficiency, these children do not need medication. This is a hereditary condition acquired from one of the parents. It does not harm the child. But if such a child marries a person having ‘Thalassemia minor’, their offspring can suffer from a serious disease called ‘Thalassemia major’. The diagnosis of thalassemia is made by doing a special test for measuring different types of haemoglobins present in the blood.

7 March, 2016

Part 4
The A-Z of Childhood Illnesses

Abdominal Pain
Abrasions or Scratches
Acute Glomerulonephritis
Acute Nephritis
Acute Watery Diarrhoea
Anorexia (Poor Appetite)
Bed-Wetting (Enuresis)
Birth Deformities
Bites and Stings
Bone, Joint and Muscle Injuries
Bowlegs and Knock-Knees
Calcium Deficiency
Cardiac Pulmonary Resuscitation
Cerebral Palsy (CP)
Cleft Lip and Palate
Common Cold
Congenital Heart Disease
Convulsions or Fits or Seizures
Dengue Fever
Diabetes Mellitus
Diarrhoea, Dysentery ...
Down's Syndrome
Earache, Ear Infections ...
Electric Shock
Eye Problems
Foot Problems
German Measles (Rubella)
Glands in the Neck ...
Head Injury
Influenza (Flu)
Joint Disorders
Limp and Pain in the Legs
Malnutrition (Undernutrition)
Menstrual Problems
Mental Retardation (MR)
Mouth To Mouth Breathing
Nephrotic Syndrome
Nose-Related Problems
Premature Baby
Prolapse of the Rectum
Rheumatic Fever
Rheumatoid Arthritis
Short Child
Skin Conditions
Sleep and Sleep Problems
Sore Throat (Pharyngitis)
Stridor (Noisy Breathing)
Teething and Care of Teeth
Tetanus (Lock Jaw)
Tracheoesophageal Fistula
Tropical Eosinophilia
Tuberculosis (TB)
Umbilical Problems
Undescended Testis
Urinary Infection
Vaginal Discharge
Whooping Cough (Pertusis)

Part 4
Keeping Your Child Healthy
Choosing A Paediatrician
Proper Use of Medicines
Home Remedies
A First Aid Kit
The A-Z of Childhood Illnesses
Psychological Concerns
Managing A Hospital Stay
Prayer And Your Child's Health
The Role of Nature Cure
Ayurveda and Child Care
Congenital Heart Disease FAQ
Guide to Child Care
1 Pregnancy, Childbirth ...
2 The Growing Years
3 Feeding Infants, ...
4 Keeping Your Child Healthy
5 Keeping Your Child Happy
About Dr. R. K. Anand

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