Anemia in Children
The most common cause of anemia is decreased production in the bone marrow. The most common causes of decreased production are iron deficiency due to nutritional deficiencies, vitamin B12 and folic acid deficiency.
Iron deficiency is the most common type of anemia in our country and all over the world. It is most common in children aged 6 months to 24 months and in adolescence. The reason why it is seen more frequently in these periods is the increasing need and the inability to meet the need with nutrients in sufficient quantities due to the rapid growth and development. Another reason is blood loss with menstrual bleeding in adolescent girls.
Iron plays a role in the development of the brain and the effective functioning of the immune system, as well as in the production of blood. If its deficiency cannot be treated in a timely manner, it can cause permanent damage to cognitive functions. There is also a risk of contracting more frequent infections than usual. In the case of anemia, loss of appetite, growth and development retardation, inability to gain weight, neuromotor developmental retardation, frequent infection, bruising while crying can be seen in young children, while in older children weakness, fatigue, dizziness, pallor, decrease in school success, distraction, hair loss. may present with symptoms such as broken nails. If anemia is severe, heart failure, palpitations, rapid breathing, enlargement of the liver and spleen may also be seen.
A detailed history, physical examination and laboratory tests are required to diagnose anemia. In the history, the age of onset, nutritional history, family history, and the presence of consanguineous marriage between the parents are important. Hereditary anemia comes to mind in anemia that has been in existence since infancy and has consanguineous marriages. In the physical examination, the general condition of the patient, pallor, jaundice, palpitation, the size of the liver and spleen, and the presence of lymph nodes should be evaluated. If iron deficiency anemia is thought, ferritin tests showing iron, iron binding capacity and iron stores are requested. If other nutritional deficiencies are considered, vitamin B12 and folic acid are requested.
First of all, adequate iron and vitamin support should be provided to mothers during pregnancy. Premature or low birth weight babies can be given protective iron support starting from the first month, and term babies can be given protective iron support from the 4th month until at least 1-year-old. With the start of additional foods, a diet rich in iron-rich red meat, liver, spleen, fish, eggs, legumes , grape molasses and dark green leafy foods should be encouraged. Cow's milk should not be given before the age of 1, as it prevents iron absorption and may cause blood loss through small bleeding from the intestines, and should be given not exceeding 2 glasses a day after 1 year of age. Drinks such as tea and coffee that reduce iron absorption should be avoided. Bleeding periods of adolescent girls should be followed, and prolonged and excessive bleeding should be examined.
Treatment of anemia varies according to the cause of anemia. If there are nutritional deficiencies such as iron deficiency or B12 deficiency, the treatment is by replacing these vitamins and elements. In iron deficiency, the amount of iron calculated according to the child's weight is prescribed in drops, syrup or tablet forms as 2 doses per day. For sufficient absorption, it can be given 2 hours after a meal on an empty stomach or with freshly squeezed orange juice containing vitamin C, which we know to increase iron absorption. After the blood values reach the desired level, the treatment should be completed for 3 months with a lower dose. Difficulty may be experienced in use due to side effects such as blackening of the teeth, darkening of the stool color, abdominal pain, nausea, constipation and diarrhea. Teeth staining is temporary, but in order to prevent it, it may be beneficial to administer the drug in a way that reduces its contact with the teeth or to drink water afterwards. If the drug cannot be used due to nausea and abdominal pain, switching to different iron preparations may reduce the complaints.
