"I" Run For Iron: Iron Deficiency Anaemia - An Untold Story

Posted On Jan 17, 2023

4 Min Read

Dr. Vinay Munikoty Venkatesh

Consultant - Paediatric Haematology Oncology & BMT

Manipal Hospitals - Yeshwanthpur - Bengaluru

Paediatric Haematologist in Yeshwantpur

Anaemia is a major health concern for growing children. Anaemia in children is a condition where the child does not have enough red blood cells or hemoglobin to carry oxygen in the blood and hence hampers normal growth. The normal hemoglobin level is defined based on age:

(i) 0–5 years: >11g/dL

(ii) 5-11 years: >11.5 g/dL

(iii) 12–15 years: >12 g/dL

The recent statistics from the National Family Health Survey (NFHS-5, 2019–2021) show a startlingly high prevalence of Anaemia in kids. Indeed, over the years, the burden of Anaemia in preschool kids (0–5 years) has increased from 58% in 2016 to 67% in 2021. Furthermore, there is no distinction between urban (64%) and rural (68%). It means, 2 out of every 3 children are anaemic. Does this mean they need treatment? "Food is the medicine"—enriching dietary modifications are very essential at different stages of growth in children.

"The Three Musketeers"—vital ingredients for nominal blood production are:

  • Iron

  • Vitamin B12  

  • Folic acid

Among these, "iron deficiency" is the major culprit in children. The iron content of blood is 1mg/ml. 

Causes of Iron Deficiency Anaemia in Children

The most common reasons for iron deficiency in a child are:

  1. Diet low in iron

  • Most of the Indian household diet is poor in iron content. Further, only a tiny portion (5–10%) of the iron content of the cooked food is absorbed.

  • Milk and milk-based foods are usually iron-deficient. Iron deficiency is more common in infants and toddlers who are exclusively breastfed.

  • Delayed introduction of solid foods on the child's plate.

  1. Birth-related causes

  • The baby gets iron stores from the mother in the last 3 months of pregnancy. The majority of Indian mothers (52%) are iron deficient, and this translates to poor iron storage in babies at birth.

  • Umbilical cord clamping should be delayed by 1-2 minutes after the birth of the baby. This ensures additional blood flow from the mother to the baby and prevents iron deficiency.

  1. Growth periods

  • The kids need more iron supply during the stages of a growth spurt. The two critical periods are:

  • Preschool: 1-5 years

  • Adolescents: 10-19 years

  • Food faddism in adolescents has been a major concern, leading to obesity and low micronutrient stores, including iron deficiency.

  1. Gastro-intestinal problems

  • Poor absorption of iron from food can happen under certain conditions in children. For example, celiac sprue.

  1. Blood loss

  • Poor absorption of iron from food can happen under certain conditions in children. Ex: Celiac sprue.

Symptoms of Iron Deficiency Anaemia

The symptoms of iron deficiency include:

  • Fatigue or easily getting tired.

  • Decreased interest in play.

  • Poor attention span.

  • Dizziness

  • Lack of sound sleep at night.

  • Reduced appetite or lack of interest in food.

  • Pale skin

  • Breathless with exertion. Ex: climbing stairs.

  • Crave for eating non-edible substances (medical term PICA). Ex: mud, door paint, etc.

Apart from causing Anaemia, iron deficiency in a growing child can result in decreased intelligence scores (Eg: poor school performance) and affect psychomotor behaviour (Eg: temper tantrums, PICA, restlessness). If your child is showing any symptoms, please consult a paediatric haematologist in Yeshwanthpur for diagnosis and treatment. 

Diagnosis and Treatment for Iron Deficiency Anaemia

Most children with Anaemia can be easily diagnosed with simple tools. The first step in diagnosis includes a detailed dietary history, comprehensive symptom analysis, and a simple blood test (haemoglobin quantification). The red blood cells appear small and pale on microscopic examination. Specific diagnostic tests called "serum iron studies" may be required. A large subset might still be iron deficient due to inappropriate food habits. This can adversely affect the child's overall development.

In these conditions, the child may need "Iron Tonics" for 3-6 months' duration. The tonics that must be given are:

a) An empty stomach or 2 hours after food. 

b) Avoid milk and calcium syrups at the same time.

c) Rinse mouth after the syrup to avoid staining of teeth.

Preventive Measures for Iron Deficiency Anaemia

A child’s diet plate must and should have iron-rich foods, namely:

  • Green leafy vegetables (spinach, broccoli, palak)-2 to 3 servings a week.

  • Legumes: mixed beans, lentils, green peas, and chickpeas-2 to 3 servings a week.

  • Dry fruits: dates and nuts (cashew nuts, almonds, dried apricots)-1 serving a day.

  • Non-vegetarian (if acceptable): red meat (chicken) and liver, once a week.

  • Utilization of raisins and jaggery while preparing food.

The traditional method of cooking in iron pots instead of aluminium utensils improves the iron content of food. Also, deworming (for intestinal worms) every 6 months from toddler age to 5 years helps reduce iron deficiency. 

The government has undertaken policies ("Anaemia Mukt Bharat") to prevent iron deficiency by supplementation of iron supplements (syrups or tablets) throughout childhood (three categories: preschool, primary school, and adolescent girls and boys).

"Iron as a metal may not shine like silver or glitter like gold, but it is the most precious micronutrient for a growing child."

Visit a top hospital for the best paediatric haematology treatment in Yeshwanthpur

Department of Haemato Oncology

Manipal Hospitals, Yeshwanthpur