The most common anemia in children is Iron-Deficiency Anemia, which can influence physical and mental growth of the child
The blood in your vessels, consist of white blood cells, Red blood cells, platelets and the plasma in which these cells swim in it. Beside the above cells, there are also proteins, lipids, sugars, vitamins and many other little bitty materials. Each of the above has a special function like Red Blood cells (RBC) that contains hemoglobin and has the function of carrying oxygen to the body’s tissues and organs. The decrease of hemoglobin or Red Blood Cells is traditionally called anemia.

The following are the lower normal hemoglobin levels below which children are considered to be anemic:

  • Newborn (full term) : 13gm/dl
  • 3 months : 9.5gm/dl
  • 1 – 3 years : 11.0gm/dl
  • 4 – 8 years : 11.5gm/dl
  • 8 – 12years : 11.5gm/dl
  • 12 – 16years : 12gm/dl

Anemia are of different types and have different causes but the basic problem causing anemia includes:

1.    Decrease Red blood cells production in the bone marrow, like leukemia.
2.    Destruction of excessive Red Blood Cell (hemolysis) in the vessels as in thalassemia.
3.    Blood loss like bleeding, the cause of which could be allergy to cow’s milk protein, parasitic infection or maybe trauma. The symptoms of anemia depend on the age of the child, the cause, and the speed of its development.  Most children with anemia are asymptomatic and infrequently may have pallor, fatigue, tiredness, jaundice, and poor gain in weight.  They may not be critically ill.  In severe chronic cases there may be dyspnea, palpitation, edema, shock, enlargement of spleen and heart, and growth disturbances. History and clinical findings on physical examination with the help of a few simple laboratory tests can reveal the underlying cause of anemia. The pallor and irritability may not show up until hemoglobin is less than 7 – 8 mg/dl.
Among many causes of anemia in children:
The most common is iron deficiency anemia. Where the body is depleted of iron and the red blood cell gets small and pale in shape. This type of anemia can influence the physical, mental growth and the ability of learning in the child. It is usually caused by poor intake of iron, like using cow’s milk, which has low iron with low bioavailability in a child less than one year, bleeding which could be secondary to being sensitive to protein of the cow’s milk, prematurely born baby whish has low iron store, and secondary to different type of sickness. One of the most common causes of iron deficiency anemia in children is low cultural awareness of the quality of foods and feeding, making use of junk foods like chocolate, chips, chewing gum, different type of liquid beverages or taking huge amount of cow’s milk daily, in the second year.

Important Notes:
1. Healthy term infants who are exclusively breastfed are at risk of iron deficiency after 5 to 6 months of age if they not use proper complimentary food besides the breast milk. This is more complicated in premature born infant, as their iron store is less.
2. Although breast milk and cow’s milk contain about the same amount of iron, non-heme iron is absorbed at 50% efficiency from breast milk but at only 10% from cow’s milk.  In addition, cow’s milk may cause microscopic gastrointestinal bleeding in younger infant as a result of mucosal injury, possibly from sensitivity to bovine albumin. In older infants, cow’s milk may interfere with iron absorption from other sources, too.
3. Screening for iron deficiency anemia should be considered for all infants between 9 – 12 months of age specially if:

  • Low birth weight
  • Consumption of the whole cow’s milk before the age of one year.
  • Use of formula not fortified with iron.
  • Exclusive breastfeeding (without solid or formula supplementation)    beyond the age of six months).
  • Perinatal Blood loss
  • Teenage female (if menstruation is heavy or if pregnant)
  • Infant living in poverty

4. Iron depletion (with or without anemia) maybe associated with lassitude, and decrease concentration ability and mood swings.
5. Bioavailability of non-heme iron is decreased by phosphates, tennates, polyphenols and oxylates found in cereal, milk, cheese, tea, and complex carbohydrates. It is increase by fructose citrate and specially ascorbic acid found in red kidney beans, cauliflower and banana. In children with iron deficiency, besides the administration or replacement of iron, a Vitamin C fortified fruit juice 30 minutes before a meal makes physiologic sense.
6. Multiple studies have shown an association between iron deficiency in infants between nine and twenty four months old and lower motor and cognitive scores and increase behavioral problems compared with non anemic controls. Some long term studies suggest that the developmental impairments maybe long lasting. Debate remains about whether this relationship remains casual and, if so, whether the correction of anemia leads to reversal of the problems.

Dr. Hossein Sardari-Zadeh
Pediatrician Specialist
Armada Medical Centre  
tel: 04-3990022