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Quick reference medical handouts used by Pediatric offices


Untreated Anemia can Stunt a Child's Growth


The blood circulating in our body is made up of red blood cells, white blood cells, platelets, and plasma. The predominant cells in the blood are the red blood cells whose primary function is to supply oxygen and nutrients to the body’s cells and to remove waste products. While adequate delivery of oxygen is important for everyone’s health, it is particularly important to the rapidly growing child. The red blood cells can transport oxygen because they contain hemoglobin, a complex protein that contains iron. Anemia results when the number of red blood cells is reduced below normal, or there is a decrease in the amount of the body’s hemoglobin. Fortunately, anemia has diminished as a major problem for children in the United States because of improved nutrition. However, certain youngsters, particularly infants and adolescent girls, remain at risk for developing anemia. If untreated, anemia can lead to an impairment of a child’s normal growth and development.

Anemia is not a diagnosis, but is a sign, much as fever may suggest the presence of an infectious disease. The exact cause of the anemia must be found before the youngster can be properly treated. Children who are anemic are often pale, irritable, tire easily, have a decreased appetite, and infection prone. Adolescents may have impaired short-term memory, have decreased exercise tolerance, or experience orthostatic hypotension (lightheadedness when changing position from lying or sitting to standing).

The most common cause of anemia in children and adolescents is due to iron deficiency, which results in a decreased production of new red blood cells. The body normally obtains its iron supply from the diet and recycling of iron from old red blood cells. Children at highest risk for developing this type of anemia are premature infants, infants born of a multiple pregnancy, infants born of anemic mothers, and children with inadequate dietary intake of iron. Adolescent girls are also at risk because their irregular eating habits (caused by concerns about body image) compounded by normal menstrual blood loss. Another less common cause of iron deficiency anemia in children is gastrointestinal blood loss associated with ulcers and certain medications.

After birth, milk is the major source of iron. Breast milk or commercially available formulas will supply the newborn with adequate amounts of iron for at least the first six months of life. Iron fortified cereals are also an important source of iron for young children. Because growth is so rapid during the first year of life, iron intake might still not meet the demands of the growing child. Therefore, many pediatricians screen the blood for anemia by getting a hemoglobin level at the nine or twelve month well-baby checkup. A drop of blood from a simple fingertip puncture is usually all that is needed. If the anemia is due to iron deficiency, additional iron may be prescribed.

The typical American diet can usually meet the body’s iron requirements after infancy. Iron-rich foods include meats (liver is the highest source), poultry, egg yolks, dark leafy green vegetables, dried fruits and whole grain bread. Milk is a poor source of iron after the age of one year.

Disorders of the hemoglobin (hemoglobinopathies), such as sickle cell anemia and thalassemia, are also important causes of anemia in children.

Sickle cell anemia is an inherited condition in which the red blood cells are destroyed faster than the body can replace them. The hemoglobin in children with sickle cell anemia is different from normal hemoglobin. Two genes are responsible for making a child’s hemoglobin molecule, one from the father and the other from the mother. If both genes produce the abnormal hemoglobin, the child has sickle cell disease. Severe anemia, delayed growth, and increased infections are commonly found in children with sickle cell disease. On the other hand, if a child receives a normal hemoglobin producing gene from one parent and one that produces the sickle hemoglobin from the other parent, the child is said to have sickle cell trait. Fortunately, sickle cell trait is not usually associated with significant anemia, and the child grows and develops normally. About 8 percent of African Americans have the inherited sickle cell trait. Children of two individuals with sickle cell trait have a one-in-four chance of being born with sickle cell disease.

In thalassemia, the genes responsible for making hemoglobin are distributed in an abnormal pattern or have defects, leading to a slowed rate of hemoglobin production. Thalassemia occurs in people of Mediterranean origin, and to a lesser extent, Chinese and African Americans. The "major" version of the disease causes severe anemia during the first year of life producing growth failure, abnormalities of the bones, and enlarged lifer and spleen. A milder form of the disease, known as thalassemia minor, produces milder anemia and usually no symptoms.

Children may become anemic because of frequent infections. Illness diminishes the youngster's appetite and slows the body’s production of red blood cells. Deficiencies of folic acid or vitamin B-12 can also cause anemia but are rare in youngsters, usually occurring because of impaired vitamin absorption. Diseases of the bone marrow (the cavity within the larger bones) where the red blood cells are produced will also cause anemia. Fortunately, these conditions are even rarer.

Worrying about their child’s health and if they could be anemia is a common concern for many parents. Children do become anemic, but probably not as often as most parents think. Thankfully, the diagnosis of anemia is easily made and in the most cases treatment is easy, safe, and effective. Restoring a normal blood count can literally breathe life into a less than active youngster. Most pediatricians screen the blood for anemia during routine well-child checkups, and parents should always consult with their child's physician if they suspect there is a problem.

 

As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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