Anemia and nutrition in children

Anemia is a global public health problem, affecting both developed and developing countries. It is estimated that around 50% of anemia cases are due to nutritional deficiencies such as iron or  Vit B12 or folic acid. Anemia (including iron deficiency anemia) is more common in girls than in boys. 

Iron is needed for many important processes inside the body. It is especially important for making hemoglobin – the protein in your blood that carries oxygen. If there is no enough iron, the body can’t make enough hemoglobin to meet its needs. Then the red blood cells become abnormally small and can’t carry enough oxygen to your organs and tissues. This leads to the symptoms of anemia. Babies, teenagers, and women who have heavy periods are more likely to get iron deficiency anemia. The recommended intake of iron increases when girls reach puberty, due to increased losses from menstruation and this puts girls of this age at greater risk of having low iron intakes and status. Iron is absorbed from food and drink by the bowel. It’s carried in the blood to the bone marrow, where blood cells are produced. Here, the iron is combined with proteins to make hemoglobin. Any iron that doesn’t get used up is stored in the bone marrow and other organs, such as the liver. If the body has a sudden demand for extra iron, one may develop iron deficiency anaemia. This can happen, for example, during a growth spurt (which is most common during the teenage years) and the body makes more red blood cells to support your developing bones, muscles and tissues.

The cause for nutritional anemia could be due to delayed weaning, blood loss, poor diet,  excessive cows milk intake, poor absorption, a period of life when iron requirements are especially high (growth spurt), heavy blood loss as a result of menstruation, infections and worm infestations.  Anemia is particularly common in girls who have tried to lose weight and among vegetarians. 

If the child feels tired quickly, looking pale, having breathlessness, feeling his heart thumping( palpitation), eating mud or ice or paint, brittle nails, and being irritable then consult the doctor and get the blood tests done. If anemia left untreated it can lead to problems with the lungs and hearts. If the blood tests show low levels of hemoglobin with small, pale, red cells, one may have iron deficiency anemia. This can be confirmed if one also has low levels of ferritin in the blood.

Treatment involves replacing iron in the body and treating a particular condition if it is causing the iron deficiency. Taking iron syrup in younger children and tablets in teenagers is the best way to make up for the shortage of iron. Iron tablets can cause side effects, such as feeling sick, heartburn, constipation, and diarrhea. By taking the tablets after meals and drinking enough fluids, one can reduce these side effects. If one cannot take iron tablets, or if they don’t work, an iron infusion through a drip into a vein can be given. Iron infusions can cause side effects, such as headache or joint pains and, occasionally, allergic reactions. If anemia is severe causing heart failure then the child will require a blood transfusion. 
The risk of developing Iron deficiency anemia can be reduced by weaning at the appropriate time in infants, eating a healthy, balanced diet that contains plenty of iron-rich foods (red meat, green vegetables, dried fruit, chickpeas, lentils, and fortified foods such as breakfast cereals).   For most children, this will provide enough iron without the need to take supplements.

 

Dr. Harsha Prasad L

Consultant - Pediatric Hemato Oncology

Manipal Hospitals, Mangalore

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