Consultant Paediatrician Olu Wilkey, talks about Childhood Anaemia

In our latest Ask the Consultant article, featured in West Essex Life Magazine, Consultant Paediatrician Dr Olu Wilkey, talks about childhood anaemia. You can read the full article here.

Anaemia is a common condition where the number of red blood cells or the amount of haemoglobin in red blood cells is less than normal.

Most commonly anaemia is caused by a lack of the mineral iron in the body. Iron is needed to form haemoglobin so a reduced iron level in the causes a reduced haemoglobin level in the blood.

Red blood cells contain haemoglobin which is the substance that makes blood red. Its main purpose is to carry oxygen around the body. If the body does not receive enough oxygen symptoms such as tiredness, weakness, lack of energy can occur.

What causes iron deficiency anaemia in children?

• Nutritional iron deficiency anaemia is the most common cause of anaemia in children. Iron sources are available from the diet but children can be very fussy with food. If not enough food with good sources of iron is consumed, over time the body can become iron deficient. Examples of iron-rich foods include red meat and offal (such as liver); leafy green vegetables (spinach and broccoli); lentils and beans; grains, for example whole wheat, brown rice and fortified breakfast cereals; dried fruit, such as raisins and apricots; pork; poultry; eggs and seafood. How you prepare food and what types of foods you eat together, can affect how much iron you absorb. For example, foods rich in vitamin C such as oranges, tomatoes, berries, kiwi fruit and capsicum, can help you absorb more iron if you eat them at the same time as iron-rich foods. You could add them raw to your plate, or drink orange juice with your meal, or take a vitamin C supplement.
• Nutritional iron deficiency can also be caused if the body does not absorb iron from the food that we eat. For example toddlers can run into problems if they drink too much cow’s milk. Cow’s milk is not a good source of iron. In fact, milk makes it harder for the body to absorb iron and can contribute to iron-deficiency anaemia.
• Blood contains iron within red blood cells. So if you lose blood, you lose some iron. Teenagers with heavy periods are at risk of iron deficiency anaemia because they lose blood during menstruation. Slow, chronic blood loss within the body — such as recurrent nose bleeds.

What are the signs and symptoms of iron deficiency anaemia in children?
Some children do not show symptoms at all, but common signs and symptoms include:

• pale skin
• fatigue / lack of energy / tiring easily
• breathlessness
• irritability
• poor appetite
• dizziness or feeling light-headed
• brittle nails
• In rare cases, a child with iron-deficiency anaemia may develop pica, a craving to eat non-food items such as paint chips, chalk, or dirt.

How is iron deficiency anaemia in children diagnosed?
Iron deficiency anaemia is usually diagnosed using blood tests. Your doctor will take a small sample of blood and ask the laboratory to carry out a full blood count (FBC) test. This will count the number of each type of blood cell present in a sample (full blood count) and check how much haemoglobin is in the red blood cells.

They might also check how much iron is in the haemoglobin. These tests will determine if anaemia is present and if so, how severe.

If the doctor thinks the anaemia is not caused by iron deficiency, further tests may be needed to work out what is causing it.

How is iron deficiency anaemia in children treated?
Treatment for childhood anaemia varies based on the diagnosis, age of the child, medical history and, overall health of the child, and his or her tolerance to specific medications.

Treatment options include:

• Changing the diet to include more iron-rich or vitamin B-12 rich foods.
• Iron or B-12 supplements in liquid and in chewable tablet form. Some children find these difficult to tolerate but there are several different iron preparations if your child has a problem with one of them. As Vitamin C can help the body absorb more iron we recommend taking the supplements with some orange juice.
• If anaemia is caused by an infection or any medical condition, treating the infection or the condition will treat anaemia.
• In more severe cases a blood transfusion may become necessary to treat some forms of chronic anaemia.

What happens next?
Treatment is usually for 4 months. Generally, symptoms improve after a month of treatment. After completing treatment a blood test should be done to rechecked and measure the iron levels. If there is good adherence, the iron stores should improve but if symptomatic or still anaemic despite all the investigations the child may need further invasive investigations where appropriate.

Dr Wilkey as clinics at The Holly Private Hospital on Thursday afternoons.