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
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.
