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Anaemia is a major health concern for growing children. Anaemia in children is a condition where the child does not have enough red blood cells or haemoglobin to carry oxygen in the blood and hence hampers normal growth. The normal haemoglobin level is defined based on age:

• 0–5 years: >11 g/dL
• 5–11 years: >11.5 g/dL
• 12–15 years: >12 g/dL

The recent statistics from the National Family Health Survey (NFHS-5, 2019–2021) show a startlingly high prevalence of Anaemia in kids. Indeed, over the years, the burden of Anaemia in preschool kids (0–5 years) has increased from 58% in 2016 to 67% in 2021. Furthermore, there is no distinction between urban (64%) and rural (68%). It means, 2 out of every 3 children are anaemic. Does this mean they need treatment? "Food is the medicine"—enriching dietary modifications are very essential at different stages of growth in children.

"The Three Musketeers"—vital ingredients for nominal blood production are:

• Iron
• Vitamin B12
• Folic Acid

Among these, "iron deficiency" is the major culprit in children. The iron content of blood is 1mg/ml.

Causes of Iron Deficiency Anaemia in Children

The most common reasons for iron deficiency in a child are:

Causes of Iron Deficiency

• Diet Low in Iron
  • Most Indian household diets are poor in iron content. Only a tiny portion (5–10%) of the iron content of cooked food is absorbed.
  • Milk and milk-based foods are usually iron-deficient.
  • Iron deficiency is more common in infants and toddlers who are exclusively breastfed.
  • Delayed introduction of solid foods can contribute to iron deficiency.
• Birth-Related Causes
  • The baby gets iron stores from the mother in the last 3 months of pregnancy. Many Indian mothers (52%) are iron deficient, leading to poor iron storage in babies at birth.
  • Umbilical cord clamping should be delayed by 1-2 minutes after birth to ensure additional blood flow from the mother to the baby and prevent iron deficiency.
• Growth Periods
  • Increased iron supply is needed during growth spurts, particularly in:
    • Preschool years (1-5 years)
    • Adolescence (10-19 years)
  • Food faddism in adolescents can lead to obesity and low micronutrient stores, including iron deficiency.
• Gastrointestinal Problems
  • Poor absorption of iron from food can occur in conditions like celiac sprue.
• Blood Loss
  • Conditions that cause poor absorption of iron, such as celiac sprue, can contribute to iron deficiency.

Symptoms of Iron Deficiency Anaemia

• Fatigue or easily getting tired
• Decreased interest in play
• Poor attention span
• Dizziness
• Lack of sound sleep at night
• Reduced appetite or lack of interest in food
• Pale skin
• Breathless with exertion (e.g., climbing stairs)
• Craving for eating non-edible substances (medical term: PICA) such as mud or door paint

Impact of Iron Deficiency in Growing Children

Apart from causing anaemia, iron deficiency in a growing child can result in:

• Decreased intelligence scores (e.g., poor school performance)
• Affected psychomotor behavior (e.g., temper tantrums, PICA, restlessness)

If your child is showing any of these symptoms, please consult a pediatric haematologist in Yeshwanthpur for diagnosis and treatment.

Diagnosis and Treatment for Iron Deficiency Anaemia

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Most children with anaemia can be easily diagnosed with simple tools. The first step in diagnosis includes:

• A detailed dietary history
• Comprehensive symptom analysis
• A simple blood test (haemoglobin quantification). The red blood cells may appear small and pale on microscopic examination.
• Specific diagnostic tests called "serum iron studies" may be required. A large subset might still be iron deficient due to inappropriate food habits, which can adversely affect the child's overall development.

In these conditions, the child may need "Iron Tonics" for a duration of 3-6 months. The tonics should be given:

• On an empty stomach or 2 hours after food
• Avoid milk and calcium syrups at the same time
• Rinse mouth after the syrup to avoid staining of teeth

Preventive Measures for Iron Deficiency Anaemia

A child’s diet plate must include iron-rich foods:

• Green leafy vegetables (spinach, broccoli, palak) - 2 to 3 servings a week
• Legumes (mixed beans, lentils, green peas, chickpeas) - 2 to 3 servings a week
• Dry fruits (dates, nuts, cashew nuts, almonds, dried apricots) - 1 serving a day
• Non-vegetarian options (if acceptable) - red meat (chicken) and liver, once a week
• Utilization of raisins and jaggery while preparing food
• Cooking in iron pots instead of aluminium utensils to improve the iron content of food
• Deworming (for intestinal worms) every 6 months from toddler age to 5 years

The government has undertaken policies ("Anaemia Mukt Bharat") to prevent iron deficiency by supplementing iron throughout childhood (three categories: preschool, primary school, and adolescent girls and boys).

"Iron as a metal may not shine like silver or glitter like gold, but it is the most precious micronutrient for a growing child."