2023 Author: Josephine Shorter | [email protected]. Last modified: 2023-05-24 11:52
Iron deficiency anemia in children
Iron deficiency anemia is a pathology that is triggered by a lack of iron in the child's body. Moreover, this deficit can be both relative and absolute. In the general structure of anemias, iron deficiency anemia accounts for about 80% of all cases. Moreover, in childhood, it occurs quite often - in 40-50% of cases. The disease does not bypass adolescents. Thus, anemia with a lack of iron is diagnosed in 20-30% of children in puberty.
Every parent who is faced with such a diagnosis begins to think about whether a child's anemia is being treated. Of course, childhood anemia can be treated, but this issue must be dealt with very seriously.
- Why does a child's body need iron?
- Symptoms of the development of anemia in a child
- Development reasons
- Causes of anemia in children 1 year old
- Classification of anemia in children
- The degree of anemia in children
- Treatment of anemia in children
- Forecast and prevention
- Recommendations for parents
Why does a child's body need iron?
Iron is one of the most important trace elements in the child's body. Without it, the synthesis of enzymes and proteins that are involved in metabolic processes is impossible.
Iron is part of a protein such as hemoglobin. It is this protein that is responsible for the transfer of oxygen to organs and tissues. If there is not enough iron, then the hemoglobin content in the blood will decrease. This will provoke hypoxia (oxygen starvation) of all systems of the human body. Cerebral tissues react especially sharply to the lack of oxygen.
Iron is found in myoglobin, catalase, cytochrome peroxidase, and a number of other enzymes and proteins. There is also a depot of this trace element in the body. Iron is stored in it in the form of ferritin and hemosiderin.
When the baby is still in the womb, he receives iron through the placenta. The most iron is required for the baby in the period from 28 to 32 weeks. It was at this time that the depot of this microelement was formed.
When a child is born, his body should have 300-400 mg of iron, which is stored in reserve. If the baby is born early, then these figures are much less and amount to 100-200 mg.
The child's body will spend this iron on the production of hemoglobin and enzymes, it takes part in the processes of tissue repair, in general, it is spent on meeting the needs of the body.
The kid grows very quickly, which determines the high need of his body for iron. Therefore, the reserves that he had at birth will run out very quickly. If the baby was born on time, then these reserves will be exhausted by 6 or even 5 months. If the baby was born too early, then he will only have enough iron up to 3 months of independent life.
Iron, which comes from the outside, is absorbed in the duodenum and in the jejunum. However, from all the amount that a person receives from food, no more than 5% of iron is absorbed. This process is influenced by the work of the digestive system. The main source of iron is red meat.
Symptoms of the development of anemia in a child
Signs of iron deficiency in a child are very diverse. There is a difference between how anemia manifests itself in 5-year-olds compared to how anemia manifests itself in 10-year-olds. Therefore, parents should have complete information on this issue, which will allow them to timely detect the first symptoms of anemia and seek medical help.
There are several syndromes that characterize childhood iron deficiency anemia: epithelial, asthenovegetative, dyspeptic, immunodeficient, cardiovascular. We should dwell on them in more detail.
Symptoms of the epithelial syndrome. The skin is very dry, cracks appear on them. The skin is severely flaky, becomes rough to the touch.
Hair and nails suffer. They become brittle, stripes appear on the nail plates. Hair falls out a lot.
The mucous membrane of the oral cavity is a kind of marker that not everything is in order with the intestines. The child's lips and tongue may become inflamed. He also often develops stomatitis, the manifestations of which are ulcers on the gums and the inside of the cheeks.
The skin itself looks unnaturally pale. Moreover, the more severe the stage of the disease, the paler the child will be.
Symptoms of the asthenovegetative syndrome. Asthenovegetative syndrome develops against the background of oxygen starvation of the brain tissues. The child often has headaches. The baby's muscle frame is weak. I have trouble sleeping. Rest at night becomes restless and shallow sleep. This negatively affects the emotional sphere of the child. He becomes whiny, moody, apathetic, or overly excitable. His mood often changes.
Possible changes in blood pressure. If the child rises abruptly from the seat, he may even faint.
Vision deteriorates. If we compare a child with peers, then he noticeably lags behind them both in physical and mental development.
An infants who develop anemia may lose the motor skills they have already acquired. Young children are normally very active. However, developing anemia significantly reduces this activity.
The child will suffer from urinary incontinence for a long time, as his sphincter is too weak to keep it in the bladder.
Symptoms of dyspeptic syndrome. Dyspeptic syndrome is expressed in a decrease in appetite, sometimes adolescent children even suffer from anorexia. Babies often spit up, they may have problems swallowing food, and flatulence is often observed.
Some children suffer from constipation and others from diarrhea.
Parents often note that the child's taste is distorted, the baby may show cravings for inedible foods. For example, he has a desire to gnaw chalk or eat sand. Also, the child may like smells that are normally disgusting. This is the smell of gasoline, paint, varnish, etc.
The spleen and liver increase in size, which can be detected by a doctor during a routine examination. The likelihood of developing intestinal bleeding increases. In general, the organs of the digestive system are malfunctioning.
Immunodeficiency syndrome symptoms. A decrease in immunity can be indicated by a prolonged increase in body temperature up to 37.5 ° C. The child is sick more often. Infections have a protracted course and are difficult to correct.
Symptoms of cardiovascular syndrome Cardiovascular syndrome develops only in severe anemia. The child's pulse and respiration become more frequent, and blood pressure decreases. The heart muscle undergoes dystrophic changes, murmurs are heard in the heart.
So that the baby does not suffer from iron deficiency immediately after birth, he must receive it with food. Per day, the volume of iron supplied from the outside should be equal to 1.5 mg. When a child reaches the age of 1-3 years, this need increases to 10 mg. The child's body loses 0.1-0.3 mg of iron per day (for young children). And teenagers' expenses are 0.5-10 mg.
If the baby spends more iron than it receives from the outside, then over time, he develops an iron deficiency. This condition is called iron deficiency anemia.
The causes of iron deficiency anemia in a child:
- The baby's hematopoietic system is not sufficiently developed.
- He is not getting adequate nutrition.
- The child has parasites.
- The child is infected.
- The child is in puberty. At this time, hormonal disruptions can lead to iron deficiency.
Also, a large amount of iron in the body is consumed during bleeding. They can happen during surgery, after injury. These are the most obvious causes of blood loss.
There are also internal factors that can cause bleeding:
- Cancer pathologies.
- Ulcerative colitis.
- Diaphragmatic hernia.
- In adolescent girls, heavy menstrual bleeding is possible.
Also, some medications that a child receives can provoke an iron deficiency in the body. Among them: salicylates, NSAIDs, glucocorticosteroids.
The bad habits that adolescents often experience can become a triggering factor for the development of anemia. This includes taking alcoholic beverages and drugs, and smoking. Other risk factors are: insufficient time for rest, violation of intestinal microflora, lack of vitamins, eating foods that interfere with the normal absorption of iron.
Causes of anemia in children 1 year old
In children of the first year of life, anemia can develop due to the impact on their body of negative factors both during intrauterine life and after the birth of the baby. Those reasons that influenced the child's body during its intrauterine existence are called antenatal factors. They prevent the iron from accumulating in the fetus in sufficient quantities. As a result, anemia develops in the baby during the period when he is still breastfed.
These factors include:
- The presence of anemia in a pregnant woman.
- Toxicosis of a pregnant woman.
- Infections transferred by the expectant mother.
- Fetoplacental insufficiency.
- Risk of miscarriage.
- Carrying several children at once.
- Placental abruption.
- Too early or too late cord ligation.
If a baby was born with a lot of weight, or, on the contrary, prematurely, then he will develop anemia with a greater degree of probability than a healthy baby. The same is true for twins and children with developmental disabilities.
In the period up to a year, anemia can manifest due to a number of postnatal factors, including:
- Feeding the baby with milk formulas that are not adapted to the age of the baby.
- Feeding your baby with whole cow or goat milk.
- The introduction of complementary foods later than the prescribed time.
- Errors in the nutrition of the child.
- Violations in the process of absorption of iron in the intestines of the crumbs.
The child must eat right. The best product for him is his mother's milk. There is not very much iron in it, but it is absorbed in the child's body quickly, since it has a special form (lactoferrin). This allows immunoglobulin A to exhibit its antibacterial properties.
Classification of anemia in children
Classification of anemia in children depending on the mechanism of development of the disease and its cause:
- Post-hemorrhagic anemias, which are provoked by blood loss (chronic and acute).
Anemias associated with impaired hematopoiesis:
- Iron deficiency anemia.
- Hereditary and acquired iron-saturated anemias.
- Megaloblastic anemias associated with a deficiency of folic acid and vitamin B12.
- Dyserythropoietic anemias (acquired and hereditary)
- Aplastic and hypoplastic anemias against the background of inhibition of hematopoiesis.
- Hereditary and acquired hemolytic anemias (autoimmune anemias, membranopathies, hemoglobinopathies, etc.).
The degree of anemia in children
At first, the child develops pre-latent anemia when iron levels begin to decline, but there is still enough iron to meet the body's needs. However, this negatively affects the activity of enzymes in the intestine. As a result, iron from food will be poorly absorbed. This is a mild stage of anemia.
The next stage in the development of anemia is latent iron deficiency. In this case, the body's depot is depleted, which affects the iron content in the serum part of the blood. The condition of a child with an average degree of anemia may be satisfactory, but the pathological processes in the body will already be started.
The next stage in the development of anemia is the stage of clinical manifestations. During this period, anemia can be detected by blood counts. In it, the content of not only hemoglobin falls, but also red blood cells.
All cells in the body begin to suffer from oxygen starvation. This negatively affects the work of internal organs. The child's immunity begins to decline, he gets sick more often, becomes susceptible to intestinal infections. Each episode impairs bowel function and leads to increased iron deficiency.
The child's brain suffers from a lack of a trace element. He begins to lag behind in mental development from his peers. At the same time, hearing and vision decrease.
To suspect anemia in a child, a doctor needs a visual examination and interviews with parents. To confirm the diagnosis, he will give a referral for blood donation.
Anemia accompanied by iron deficiency will be indicated by the following results:
- Hemoglobin in the blood decreases below 110 g / l.
- The blood color index is below 0.86.
- The serum iron content falls below 14 μmol / l.
- The OZHSS indicator is growing and exceeds the 63 mark.
- Serum ferritin decreases to 12 μg / L and below.
- The size of erythrocytes decreases, their shape is deformed.
Depending on the level of hemoglobin in the blood, the doctor can determine the stage of development of anemia:
- If hemoglobin is at around 91-110 g / l, then they speak of a mild course of anemia.
- If the hemoglobin level drops to 71-10 g / l, then this indicates a moderate course of the disease.
- If the hemoglobin is below 70 g / l, then the child has severe anemia.
- When hemoglobin does not exceed 50 g / l, the anemia is super severe.
To clarify the cause of anemia, the doctor may prescribe a number of additional laboratory tests, including:
- Bone marrow puncture collection with further examination. With iron deficiency anemia, a decrease in the level of sideroblasts is observed.
- Delivery of feces for the determination of latent blood in it.
- Delivery of the sea otter for the determination of parasite eggs in it.
- Delivery of feces analysis for dysbiosis.
In addition, the child may need to undergo an ultrasound examination of internal organs, FGDS, irrigoscopy and colonoscopy.
Treatment of anemia in children
Childhood anemia responds well to treatment when the cause is established. Otherwise, the fight against the disease will be long and meaningless. If anemia develops against the background of massive blood loss, then the decision on how to treat it should be urgent. The child needs a red blood cell transfusion or will die.
When a child is diagnosed with chronic blood loss, for example, with ulcerative colitis, efforts should be made to eliminate the underlying disease.
With heavy menstrual flow, the girl needs to be taken to an appointment with a gynecologist. She may need hormonal correction. You may also need the help of an endocrinologist.
If parasite eggs are found in the feces, then deworming of all family members should be carried out.
Complex measures aimed at treating iron deficiency anemia:
- It is necessary to correct the child's menu.
- Regular measures must be followed, according to the age of the child. He should spend enough time in the fresh air, engage in physical activity, go to bed on time.
- On the recommendation of the doctor, the child should receive iron supplements.
- Depending on the symptoms of the disease, efforts should be made to eliminate them.
Diet is a prerequisite for getting rid of anemia. The child should eat well. The best product for a baby is mother's milk. It contains iron, which is absorbed as fully as possible by the intestines of the crumbs.
During the first year of life, the baby's metabolic processes are very active, so the iron supply that he received from the mother is very quickly depleted. In this regard, the supply of a trace element should be carried out during the introduction of complementary foods, with food.
If the infant is diagnosed with anemia, then complementary foods are introduced to him a month earlier. It is not recommended to offer such children rice porridge, semolina and bearberry. Emphasis should be placed on yachts, buckwheat and millet. Meat is offered to babies with anemia starting from six months. If a child is bottle-fed, then he should receive formula that is additionally fortified with iron.
If the child suffers from disorders in the functioning of the digestive system, then herbs can be offered to him. It is useful to give your baby decoctions of rosehip, nettle, dill, mint, elecampane, red clover, etc. However, before starting treatment, you need to consult a doctor. It is also necessary to carefully monitor the reaction of the crumbs' body to such drinks and not to miss the development of an allergic reaction.
If anemia is diagnosed in a child over a year old, then his diet should be enriched with foods that are sources of iron, among them:
- Red meat: beef and veal.
- Beef tongue and calf kidneys.
- A fish.
- Pig liver.
- Oysters and seaweed.
- Wheat bran.
- Chicken egg yolk.
- Oatmeal flakes.
- Buckwheat grain.
- Walnuts and hazelnuts, pistachios.
- Fruits: apples, peaches, etc.
There are also foods that should be excluded from the menu of a child with anemia, or their consumption should be minimized. They prevent the iron from being absorbed normally, which only helps to strengthen it.
These products include:
- Chocolate, black tea, cocoa, beets, spinach, peanuts, almonds, sesame seeds, lemon, soy products, sunflower seeds. These foods contain oxalates that prevent the iron from being fully absorbed.
- Phosphates have a similar effect as oxalates. They are especially abundant in sausages, processed cheese, and canned milk.
- In addition to oxalates, tea contains tannins. Their consumption by children with anemia should be limited.
- A preservative such as ethylenediaminetetraacetic acid is dangerous for a child with anemia.
In addition, the absorption of iron is negatively affected by the intake of certain drugs, for example, antacids and antibiotics from the tetracycline group.
The following substances can enhance the absorption of iron in the stomach: ascorbic, malic and citric acid, fructose. The same group includes the drugs Cysteine and Nicotinamide.
Treatment of anemia is impossible without taking medications containing iron. It is allowed to use complex medicines, which, in addition to this trace element, contain other useful additives.
The following drugs are used to treat childhood anemia:
- Ferrous fumarate.
- Ferrum lek.
- Maltofer foul, etc.
If the child is small, then he is prescribed drugs in liquid form (in suspension, drops or syrup). The drug Maltofer and Ferlatum are well absorbed by the body. The main active ingredients on which these funds are based do not interact with products and rarely provoke the development of undesirable health effects.
The dose of the drug should be selected by the doctor, based on the test results. It can be increased gradually, gradually bringing it to the required level. If a child takes drugs by mouth, then they should be given 1-2 hours before meals. The medicine is washed down with water or juices.
After 7-14 days, there should be a positive trend in treatment. The number of reticulocytes and hemoglobin in the child's blood will increase. Normally, the hemoglobin level should rise to 10 g / l after 7 days. Therefore, blood tests will need to be taken regularly.
If, after 30 days from the start of therapy, the hemoglobin level has not returned to normal, then you need to look for another cause of anemia.
She can hide in the following states:
- The child has blood loss, the source of which cannot be established.
- The iron dosage is too low to make up for the iron deficiency.
- There is a lack of vitamin B12 in the body.
- The child has worms or inflammation of the organs that make up the digestive system. Also, the presence of any neoplasm inside the body cannot be ruled out.
If the child does not tolerate the intake of iron-containing drugs, then he is prescribed an injection of the drug. Also, injections are used when a child develops acute anemia, characterized by a severe course and in the absence of effect after 14 days from the start of treatment. Injection of the drug is indicated when it is impossible to assimilate iron in the intestine, for example, against the background of ulcerative colitis.
Since with iron deficiency anemia, the child's body is most likely to suffer from a lack of vitamin, doctors prescribe the intake of vitamin-mineral complexes. Also, on the recommendation of a doctor, it is allowed to take homeopathic medicines.
In severe anemia, rh-EPO drugs are prescribed - epoins a and b. This allows you to refuse transfusion of erythrocyte mass to the child, since blood transfusion is associated with a high risk of complications. Recombinant human erythropoietin is administered subcutaneously. These can be Eprex and Epocran drugs.
Contraindications for treatment with iron preparations are:
- Sideroachrestic anemia (iron-saturated anemia). In this disorder, during the production of hemoglobin in the bone marrow, iron is not used, which causes its low concentration in erythrocytes.
- Hemosiderosis. The reasons for the development of this disease remain unknown. It is possible that the pathology is of an autoimmune nature. The vessels are damaged, the erythrocytes go beyond the bloodstream, which leads to the accumulation of hemosiderin in the skin.
- Hemochromatosis is a disease that is accompanied by impaired absorption of iron in the intestine. It begins to accumulate in the cells of internal organs and provokes their fibrosis.
- If the lack of iron in the child's body is only an assumption of the parents or the doctor, but tests to determine its level in the blood have not been carried out.
- Hemolytic anemia, accompanied by massive death of erythrocytes.
Therefore, before starting treatment, it is necessary to carry out a comprehensive diagnosis to exclude all contraindications to the appointment of iron preparations.
Forecast and prevention
If the reason why the child has anemia has been established, and the treatment was prescribed on time, then the prognosis for full recovery is favorable. When therapy is delayed, iron deficiency will increase. This will entail a delay in the physical and mental development of the child, deterioration of immunity and frequent illness.
Preventive measures designed to prevent anemia should be carried out both during the intrauterine development of the baby and after his birth.
Prevention measures for fetal anemia that a pregnant woman should take:
- She needs to observe the daily regimen: enough time to rest, walk as much as possible in the fresh air.
- Be sure to follow the rules of a healthy diet.
- According to the doctor's prescription, a woman needs to take iron supplements and vitamins.
- Anemia in a pregnant woman must be detected and treated in time.
Prevention of anemia in the period after the birth of a child consists of the following measures:
- If possible, the baby should be breastfed.
- Complementary foods should be introduced according to age standards. Products must be carefully selected.
- If the child is bottle-fed, then the formula should be adapted according to his age.
- It is important to follow the basic rules of caring for your baby.
- The pediatrician should check the child regularly. It is unacceptable to ignore planned visits to the doctor.
- It is imperative to deal with the prevention of rickets and anemia.
Every child, regardless of his age, should spend as much time as possible in the fresh air, eat right, do gymnastics, and visit a masseur. A prerequisite for the full growth and development of children is compliance with regime activities. If the child is at risk of developing anemia, then he is prescribed a course of iron supplements.
They are shown to the following children:
- Children born prematurely.
- Children with congenital malformations.
- Children with malabsorption syndrome.
- Children during periods of rapid growth and development, as well as adolescents during puberty.
- Girls during heavy menses.
- After bleeding, regardless of the etiological factor.
- After operation.
If a child was born prematurely, then starting from 2 months and up to 2 years, they are prescribed iron preparations for a preventive purpose. RF-EPO can also be used.
Recommendations for parents
Iron deficiency anemia is a disease that often occurs in childhood. Prevention of anemia should be done even during the intrauterine development of the baby. After his birth, measures aimed at preventing anemia should be continued. It is imperative to donate blood for analysis, which will allow detecting pathology in the early stages of its development. If treatment is started on time, it will be possible to avoid serious complications of the disease.
The author of the article: Sokolova Praskovya Fedorovna | Pediatrician
Education: Diploma in the specialty "General Medicine" received at the Volgograd State Medical University. A specialist certificate was immediately received in 2014.