anemia in Children: Symptoms, Causes, Diagnosis and Management

Insufficient hemoglobin in blood leading to its decreased capacity to carry oxygen to the body’s tissues is termed as anemia. It is acknowledged as a serious global public health problem by the World Health Organization (WHO), with an estimate of 42% of children less than 5 years of age being anemic. In children, age group less than 5 years and teenagers are most vulnerable to anemia, owing to high iron requirements needed for growth. In this article, Dr. Silky Jain, Pediatric Haemato-Oncologist and BMT Physician at Jaypee Hospital, Noida is explains all about anemia in children.

Symptoms of anemia in children

In small children, the most common anemia in children symptoms are:

• irritability
• fatigue
• decreased physical activity due to lack of oxygen in blood

Older children may also complain of:

• weakness
• headache
• dizziness
• lack of concentration

In severe cases, it may lead to compromised heart function causing palpitations and shortness of breath. Some cases of iron deficiency anemia may present with a condition called ‘pica’, wherein there is craving to eat unusual items, like dirt, clay, chalk, ice etc.
On examination, child’s skin may appear pale due to deficiency of hemoglobin, which is red in colour. Pallor (paleness) is particularly visible in conjunctiva of eyes, palms of the hand and tongue. In advanced cases, certain nail changes (flattening, spooning), cracking of angle of mouth, inflamed tongue, increased heart rate and swelling of feet may be seen.

Causes of anemia in children

Here are some major causes of anemia in children

1. Decreased production of blood

The most common cause of anemia is deficiency of nutrients needed for the synthesis of hemoglobin – iron deficiency being the most common. Others include vitamins like folate (folic acid) or vitamin B12 deficiency. Common Nutritional deficiencies in children can happen because of reduced intake or impaired absorption of nutrients from intestine e.g Celiac disease (Gluten intolerance). Hook-worm infestation of the intestines can also cause nutritional anemia. Also, a bone marrow disorder, for instance bone marrow failure or infiltration of bone marrow with abnormal cancer cells, can present as anemia.

2. Increased destruction of blood (Hemolytic)

This can happen when the production of blood is adequate, but it gets destroyed. For example:

• Due to autoimmunity wherein our body’s immune system recognizes self as
• foreign and reacts against our own red blood cells (RBCs).
• Due to hereditary causes, for instance Thalassemia, sickle cell anemia, hereditary spherocytosis. In this inherited/genetic cause of anemia, the hemoglobin itself or the RBCs which carry the hemoglobin might be defective leading to easy destruction of RBCs.

3. Blood loss

It may happen due to any cause like trauma or bleeding disorder. In teenager girls, heavy menstrual bleeding is a common cause of anemia. Besides, infections such as malaria or chronic diseases such as arthritis, kidney disease can also cause anemia.

Diagnosis of anemia

The diagnosis is established by a blood test called complete blood count (CBC) which reflects the quantity of hemoglobin in our blood. As per WHO, the cut-off of anemia in children aged < 5 years of age is <11 gm/dl; 5 to 11 years: <11.5 gm/dl, 12 to 14 years: <12 gm/dl. It can vary in severity from mild to moderate to severe. To ascertain the cause, certain other blood tests may be recommended. In rare cases, bone marrow aspirate examination may be required.

How To Manage Anaemia In Children?

• Even after correction of anemia, it is important to continue the supplements for iron replenishment.
• Iron supplements and main meals should be spaced out from calcium-rich products like milk/milk-products and also tea/coffee which are known to hamper iron absorption from the gut.
• Vitamin C increases absorption of iron, thus it’s beneficial to take iron tablets with citric juices.
• It is important to consume iron-rich food items, including green leafy vegetables, cereals especially ragi, jaggery, beans and germinated legumes, nuts (pistachios, almonds, dates) and red meat.
• De-worming might help in cases of iron deficiency due to worm infestation.

Conclusion

Only a minority of cases may require blood transfusion for correction of anemia. It should be avoided as much as possible because of the concomitant risk of infection or allergic reaction. If essential, blood transfusion should be taken at a place with safe injection practices, where NAAT testing is available to check for common blood-transmitted infections. An expert pediatric hematologist advice with regular follow-up is needed in cases of bone marrow failure, cancer, hemolytic anemia or thalassemia.