Iron-Deficiency Anemia
Iron-deficiency anemia occurs when the body does not have enough iron to produce Hgb. In the United States, iron-deficiency anemia has a peak prevalence in children between the ages of 6 and 20 months, and again at the age of puberty . Cow's milk consumption contributes to iron-deficiency anemia in older infants and young children due to its poor iron availability. The heme portion of Hgb consists of iron surrounded by protoporphyrin. When not enough iron is available to the bone marrow, Hgb production is reduced. Adequate dietary intake of iron is required for the body to make enough Hgb. As Hgb levels decrease, the oxygen-carrying capacity of the blood is decreased, resulting in weakness and fatigue. In addition to delayed growth, irondeficiency anemia has been associated with cognitive delays and behavioral changes.
Signs and Symptoms
Common signs and symptoms may include irritability headache dizziness weakness shortness of breath Pallor and fatigue. Other symptoms may be subtle and difficult for the clinician to identify; these include difficulty feeding, pica, muscle weakness, or unsteady gait.
The reasons that may lead to iron deficiency anemia : • Maternal anemia during pregnancy. • Poorly controlled diabetes during pregnancy . • Prematurity, low birth weight, or multiple birth. • Cow's milk consumption before 12 months of age. • Excessive cow's milk consumption (greater than 24 ounces a day). • Infant consumption of low-iron formula. • Lack of iron supplementation after age 6 months in breastfed infants. • Excessive weight gain. • Chronic infection or inflammation. • Chronic or acute blood loss . • Restricted diets . • Use of medication interfering with iron absorption, such as antacids . • Low socioeconomic status . • Recent immigration from a developing country .
Recommended dietary daily intake for iron in children is: • 0 to 6 months: 0.27 mg • 6 to 12 months: 3 mg • 1 to 3 years: 7 mg • 4 to 8 years: 11 mg • 9 to 13 years: 8 mg • Boys 14 to 18 years: 11 mg • Girls 14 to 18 years: 15 mg
Laboratory and Diagnostic Tests Laboratory evaluation will reveal decreased Hgb and Hct, decreased reticulocyte count, microcytosis, hypochromia, decreased serum iron and ferritin levels, and an increased free erythrocyte protoporphyrin (FEP) level.
Iron Supplement Administration : The use of iron supplements in infants begins with the use of formula fortified with iron in the formula-fed infant. Oral supplements may also be necessary if the baby's iron levels are extremely low. Oral supplements or multivitamin formulas that contain iron are often dark in color because the iron is pigmented. Teach parents to precisely measure the amount of iron to be administered. Parents should place the liquid behind the teeth, as iron in liquid form can stain the teeth. Iron supplementation can also cause constipation. In some cases reducing the amount of iron can resolve this problem, but stool softeners may be necessary to control painful or difficult-to-pass stools. Encourage parents to increase their child's fluid intake and include adequate dietary fiber to avoid constipation
References
Marilyn.J.H ,Wilson.d.,(2015).Wong Nursing care of infants and children .(10th addition ), pages 454 and 462