Iron deficiency anemia in infants and young children. Iron deficiency anemia in children: symptoms, treatment, causes Anemia in a child 1 year treatment

Anemia and anemic syndrome, caused by many causes, can be mentioned among the most common pathological conditions that general pediatricians have to deal with on a daily basis. This group includes various diseases and pathological conditions characterized by a decrease in the content of hemoglobin and/or erythrocytes per unit volume of blood, leading to impaired oxygen supply to tissues. The following laboratory criteria for anemia apply (N. P. Shabalov, 2003). Depending on the age of children, the hemoglobin level is:

• 0-1 day of life -< 145 г/л;
• 1-14 days of life -< 130 г/л;
• 14-28 days of life -< 120 г/л;
• 1 month - 6 years -< 110 г/л.

Of all the anemias, the most common is iron deficiency anemia (IDA), which accounts for approximately 80% of all anemias. According to the World Health Organization (WHO), more than 500 thousand people in the world suffer from IDA. The prevalence of IDA in children in Russia and developed European countries is: about 50% in young children; more than 20% - in older children.

IDA is a clinical and hematological syndrome characterized by a violation of hemoglobin synthesis as a result of iron deficiency, which develops against the background of various pathological (physiological) processes, and is manifested by signs of anemia and sideropenia.

Iron is one of the main trace elements in the human body. Normally, the body of an adult contains 3-5 g of iron in a bound form. 70% of the total amount of iron is part of hemoproteins. Iron in these compounds is associated with porphyrin. The main representative of this group is hemoglobin (58% iron); iron is also found in myoglobin (8%), cytochromes, peroxidases, catalase - up to 4%. Iron is also a part of non-heme enzymes (xanthine oxidase, nicotinamide adenine dinucleotide (NADH) dehydrogenase, aconitase, localized in mitochondria); transport form of iron (transferrin, lactoferrin). Iron stores in the body exist in two forms: in the form of ferritin (up to 70%) and hemosiderin (up to 30%). A feature of the distribution of iron in young children is that they have a higher iron content in erythroid cells and less iron is in muscle tissue.

Iron absorption occurs mainly in duodenum and proximal jejunum. The daily diet usually contains about 5-20 mg of iron, and only about 1-2 mg per day is absorbed. The degree of absorption of iron depends both on its amount in the food consumed and bioavailability, and on the state of the gastrointestinal tract (GIT).

Iron is more easily absorbed in the composition of heme (meat products) - 9-22%. Absorption of non-heme iron is determined by diet and gastrointestinal secretion.

Iron absorption is especially active from breast milk, although its content in it is small - only 1.5 mg per liter; the bioavailability of iron in breast milk is up to 60%. This is facilitated by the special form in which it is presented - in the form of the iron-containing protein lactoferrin. Two active binding sites for Fe 3+ ions have been identified in the lactoferrin molecule. Lactoferrin is found in breast milk in saturated and unsaturated forms. The ratio of lactoferrin forms varies depending on the period of lactation. During the first 1-3 months of life, the saturated iron transport form of lactoferrin prevails. The presence of specific receptors for lactoferrin on the epithelial cells of the intestinal mucosa promotes adhesion of lactoferrin with them and its more complete utilization. In addition, lactoferrin, by binding excess iron not absorbed in the intestine, deprives the conditionally pathogenic microflora of a microelement necessary for its vital activity and triggers nonspecific bactericidal mechanisms. It has been established that the bactericidal function of immunoglobulin A is realized only in the presence of lactoferrin.

Physiological loss of iron with urine, sweat, feces, through the skin, hair and nails does not depend on gender and amounts to 1-2 mg per day, in women during menstruation - 2-3 mg per day. In children, iron loss is 0.1-0.3 mg per day, increasing to 0.5-1.0 mg per day in adolescents.

The daily need of the child's body for iron is 0.5-1.2 mg per day. In children early age due to the rapid pace of growth and development, there is an increased need for iron. During this period of life, iron stores are rapidly depleted due to its increased consumption from the depot: in premature babies by the 3rd month, in full-term babies by the 5-6th month of life. To ensure the normal development of the child, the daily diet of a newborn should contain 1.5 mg of iron, and in a child of 1-3 years old - at least 10 mg.

Iron deficiency in children leads to an increase in infectious diseases of the respiratory and gastrointestinal tract. Iron is necessary for the normal functioning of the brain structures; if it is insufficient, the neuropsychic development of the child is disturbed. It has been established that in children who had iron deficiency anemia in infancy, at the age of 3-4 years, disturbances in the transmission of nerve impulses from the centers of the brain to the organs of hearing and vision are determined due to impaired myelination and, as a consequence, impaired nerve conduction.

The causes of iron deficiency in children are very diverse. The main cause of IDA in newborns is considered to be the presence of IDA or latent iron deficiency in the mother during pregnancy. Antenatal causes also include a complicated course of pregnancy, impaired uteroplacental circulation, feto-maternal and feto-placental bleeding, fetal transfusion syndrome in multiple pregnancies. Intranatal causes of iron deficiency are: fetoplacental transfusion, premature or late umbilical cord ligation, intranatal bleeding due to traumatic obstetric aids, or malformations of the placenta or umbilical cord. Among the postnatal causes of sideropenic conditions, insufficient intake of iron with food is in the first place. At the same time, newborns who are bottle-fed with unadapted milk mixtures, cow and goat milk suffer the most. Other postnatal causes of IDA are: increased body demand for iron; iron loss in excess of physiological; diseases of the gastrointestinal tract, syndrome of impaired intestinal absorption; deficiency of iron stores at birth; anatomical congenital anomalies (Meckel's diverticulum, intestinal polyposis); the use of foods that inhibit the absorption of iron.

At risk are always premature babies and children born with a very large mass, children with a lymphatic-hypoplastic type of constitution.

In children of the first year of life, iron deficiency is most often caused by an unbalanced diet, in particular, feeding exclusively with milk, vegetarianism, and insufficient consumption of meat products.

Recognizing the cause of the development of IDA in each case is extremely important. Orientation to nosological diagnostics is necessary, since in most cases, in the treatment of anemia, it is possible to influence the underlying pathological process.

IDA is manifested by general symptoms. One of the main and visible signs is the pallor of the skin, mucous membranes, conjunctiva of the eyes. Attention is drawn to general lethargy, capriciousness, tearfulness, slight excitability of children, a decrease in the general tone of the body, sweating, lack or decrease in appetite, superficial sleep, regurgitation, vomiting after feeding, decreased visual acuity. Changes in the muscular system are revealed: the child hardly overcomes physical activity, weakness, fatigue are noted. In children of the first year of life, regression of motor skills may be observed.

In the second half of life and in children older than a year, there are signs of epithelial tissue damage - roughness, dry skin, angular stomatitis, painful cracks in the corners of the mouth, glossitis or atrophy of the oral mucosa, fragility and dullness of hair, their loss, dullness and brittleness of nails, tooth decay (caries), lag in physical and psychomotor development.

Depending on the severity of the disease, symptoms of damage to organs and systems are revealed: cardiovascular - in the form of functional heart murmur, tachycardia; nervous system - in the form of headaches, dizziness, fainting, orthostatic collapse. Perhaps an increase in the size of the liver, spleen. On the part of the gastrointestinal tract, there is difficulty in swallowing, bloating, diarrhea, constipation, taste perversion - the desire to eat clay, earth.

The diagnosis of IDA is made on the basis of the clinical picture, laboratory signs of anemia and iron deficiency in the body: hypochromic (color indicator< 0,85) анемия различной степени тяжести, гипохромия эритроцитов, снижение средней концентрации гемоглобина в эритроците (менее 24 пг), микроцитоз и пойкилоцитоз эритроцитов (в мазке периферической крови); уменьшение количества сидеробластов в пунктате костного мозга; уменьшение содержания железа в сыворотке крови (< 12,5 мкмоль/л); повышение общей железосвязывающей способности сыворотки (ОЖСС) более 85 мкмоль/л (показатель «голодания»); повышение уровня трансферрина в сыворотке крови, при снижении его насыщения железом (менее 15%); снижение уровня ферритина в сыворотке (< 15 мкг/л).

Treatment of IDA

Treatment of IDA in young children should be comprehensive and based on four principles: normalization of the regimen and nutrition of the child; possible correction of the cause of iron deficiency; the appointment of iron preparations; concomitant therapy.

The most important factor in the correction of iron deficiency is a balanced diet, and especially breastfeeding. Breast milk not only contains iron in a highly bioavailable form, but also increases the absorption of iron from other products consumed simultaneously with it. However, intensive metabolic processes in infants lead to the fact that by the 5-6th month of life, antenatal iron stores are depleted even in children with a favorable perinatal history and babies fed with breast milk.

Among other foods, the largest amount of iron is found in pork liver, beef tongue, veal kidney, egg yolk, oysters, beans, sesame, seaweed, wheat bran, buckwheat, pistachios, chickpeas, peaches, oatmeal, spinach, hazelnuts and others ( ).

Iron absorption is inhibited by tannins contained in tea, carbonates, oxalates, phosphates, ethylenediaminetetraacetic acid used as a preservative, antacids, tetracyclines. Ascorbic, citric, succinic and malic acids, fructose, cysteine, sorbitol, nicotinamide increase the absorption of iron.

Long walks in the fresh air, normalization of sleep, a favorable psychological climate, prevention of acute respiratory viral infections (ARVI), and limitation of physical activity are necessary. The child's diet should be balanced and include iron-rich foods and substances that enhance its absorption in the intestines. Children with IDA should be introduced to complementary foods 2-4 weeks earlier than healthy children. The introduction of meat complementary foods is advisable to start at 6 months. You should refuse to introduce into the child's diet such cereals as semolina, rice, oatmeal, giving preference to buckwheat, barley, millet.

However, these measures are insufficient and do not lead to a cure for IDA, so iron preparations are the mainstay of therapy. The main ones used orally include: ferric iron compounds - hydroxide-polymaltose complex (iron polymaltose), maltofer, maltofer foul, ferrum lek and iron-protein complex (iron protein succinylate) - ferlatum; ferrous iron compounds - actiferrin, ferroplex, tardiferon, haemofer, totem, iron fumarate, ferronat.

Therapy should be started with oral preparations and only if they are poorly tolerated (nausea, vomiting, diarrhea), malabsorption syndrome, resection of the small intestine, etc. - iron preparations are prescribed parenterally. When prescribing oral forms, preference should be given to non-ionic iron compounds - protein (ferlatum) and hydroxide-polymaltose Fe 3+ complexes (maltofer, maltofer foul, ferrum lek). These compounds have a large molecular weight, which makes it difficult for them to diffuse across the intestinal mucosal membrane. They come from the intestines into the blood as a result of active absorption. This explains the impossibility of an overdose of drugs, unlike salt compounds of iron, the absorption of which occurs along a concentration gradient. Their interaction with food components and drugs does not occur, which allows the use of non-ionic iron compounds without disturbing the diet and therapy of concomitant pathology. Their use significantly reduces the incidence of side effects usually observed when prescribing oral iron preparations (nausea, vomiting, diarrhea, constipation, etc.). In addition, in young children, the dosage form of the drug is of great importance. At this age, it is convenient to use drops and syrups, which, among other things, provides the possibility of accurate dosing of drugs and does not cause a negative attitude of the child.

When prescribing any iron preparations, it is necessary to calculate the individual need for it for each patient, based on the fact that the optimal daily dose of elemental iron is 4-6 mg/kg. The average daily dose of iron in the treatment of IDA is 5 mg/kg. The use of higher doses does not make sense, since the amount of absorption of iron does not increase.

The use of parenteral iron preparations is indicated for the rapid achievement of an effect in severe anemia; pathology of the gastrointestinal tract, combined with malabsorption; nonspecific ulcerative colitis; chronic enterocolitis; with severe intolerance to oral forms of drugs. To date, in the Russian Federation, only one drug is allowed for intravenous administration - venofer (iron sugar), ferrum lek can be used for intramuscular injection.

It must be remembered that in young children, iron deficiency is never isolated and is often combined with a lack of vitamins C, B 12, B 6, PP, A, E, folic acid, zinc, copper, etc. This is due to the fact that alimentary insufficiency and impaired intestinal absorption, leading to iron deficiency, also affect the saturation of these micronutrients. Therefore, it is necessary to include multivitamin preparations in the complex therapy of IDA.

The effectiveness of IDA therapy can be judged after 7-10 days by a 2-fold increase in reticulocytes compared to the initial amount (the so-called reticulocyte crisis). An increase in hemoglobin is also estimated, which should be 10 g / l or more per week. Accordingly, the achievement of the target hemoglobin level is observed on average after 3-5 weeks from the start of therapy, depending on the severity of anemia. However, treatment with iron preparations should be carried out in sufficient doses and for a long time (at least 3 months), even after normalization of hemoglobin levels, in order to replenish iron stores in the depot.

Contraindications to the appointment of iron preparations are:

• lack of laboratory confirmation of iron deficiency;
• sideroahrestic anemia;
• hemolytic anemia;
• hemosiderosis and hemochromatosis;
• infection caused by gram-negative flora (enterobacteria, Pseudomonas aeruginosa, Klebsiella).

With the development of severe anemia, accompanied by inhibition of erythropoiesis and a decrease in the production of erythropoietin, the appointment of drugs of recombinant human erythropoietin (rhEPO) is indicated. Of particular importance is the use of rhEPO in the development of early anemia of prematurity, which develops in the second month of life and occurs, according to various authors, in 20-90% of cases. The administration of rhEPO preparations (recormon, eprex, epocrine) leads to a sharp activation of erythropoiesis and, as a result, to a significant increase in iron requirements.

Therefore, the use of rhEPO is an indication for the administration of iron preparations, usually parenteral. Currently, in the Russian Federation, a- and b-epoetins are allowed for use, which are included in the list of additional drug provision. The appointment of rhEPO allows in most cases to avoid blood transfusions, in which the likelihood of complications (transfusion reactions, sensitization, etc.) is high. The preferred route of administration for rhEPO preparations, especially in early childhood, is subcutaneous. The subcutaneous route of administration is safer and more economical, since smaller doses are needed to achieve the effect than with intravenous administration. Until recently, in the countries of the European Union and in the Russian Federation, for the treatment of hyporegenerative anemia in children, mainly β-erythropoietins were used, which, when administered subcutaneously, did not cause significant adverse reactions in contrast to a-erythropoietins, with subcutaneous administration of which there was a high risk of developing red cell aplasia. The most widely used among β-erythropoietins was the drug Recormon (F. Hoffmann-La Roche), which is convenient to use and leads to a rapid increase in the level of erythrocytes and reticulocytes without affecting leukopoiesis, increases the level of hemoglobin, as well as the rate of iron incorporation into cells.

Since 2004, subcutaneous administration of a-erythropoietins has been allowed in European countries, among which eprex (Jansen-Silag) and epocrine (Sotex-GosNII OCHB) are most commonly used in our country.

The goal of rhEPO treatment is to achieve a hematocrit of 30-35% and eliminate the need for blood transfusions. The values ​​of the target hemoglobin concentration may vary depending on the days and months of the child's life, but cannot be lower than 100-110 g/l. Depending on the dose, the target values ​​of hemoglobin concentration and hematocrit are achieved after about 8-16 weeks of treatment with rhEPO.

In order to prevent IDA, rhEPO is prescribed to premature newborns born with a body weight of 750-1500 g before the 34th week of pregnancy.

Treatment with erythropoietin should begin as early as possible and continue for 6 weeks. Recormon is administered subcutaneously at a dose of 250 IU/kg 3 times a week. However, it must be taken into account that the younger the child, the higher doses of erythropoietin he needs, so the dose can be increased.

As mentioned above, rhEPO therapy leads to a sharp increase in iron consumption, therefore, in most cases, especially in premature babies, the serum ferritin content decreases simultaneously with an increase in hematocrit. The rapid depletion of iron stores in the body can lead to IDA. Therefore, all patients receiving rhEPO therapy should be prescribed iron supplements. Therapy with iron preparations should continue until the level of serum ferritin is normal (at least 100 μg / ml) and transferrin is saturated (at least 20%). If the serum ferritin concentration remains persistently below 100 mcg/ml or there are other signs of iron deficiency, the dose of iron should be increased, including the use of parenteral preparations.

Prevention of IDA in young children includes: antenatal ( correct mode and nutrition of a pregnant woman, timely detection and treatment of anemia in a pregnant woman, preventive administration of iron supplements to women at risk for the development of IDA); postnatal (compliance with the hygienic conditions of the child’s life, long-term breastfeeding and timely introduction of complementary foods, an adequate choice of formula for children who are on mixed and artificial feeding, prevention of the development of rickets, malnutrition and SARS in a child). In the prophylactic appointment of iron preparations need:

• women of reproductive age suffering from heavy and prolonged menstrual bleeding;
• regular donors;
• pregnant women, especially repeated pregnancies following with a short interval;
• women with iron deficiency during lactation.

Prophylactic administration of iron preparations is indicated for children at risk for the development of IDA:

• premature babies (from 2 months of age);
• children from multiple pregnancy, complicated pregnancies and childbirth;
• large children with high rates of weight gain and growth;
• children with constitutional anomalies;
• suffering from atopic diseases;
• those who are artificially fed with non-adapted mixtures;
• with chronic diseases;
• after blood loss and surgical interventions;
• with malabsorption syndrome.

The dose of iron prescribed for prophylactic purposes depends on the degree of prematurity of the child:

• for children with birth weight less than 1000 g - 4 mg Fe / kg / day;
• for children with birth weight from 1000 to 1500 g - 3 mg Fe / kg / day;
• for children with birth weight from 1500 to 3000 g - 2 mg Fe / kg / day.

The significance of the problem of IDA in young children is due to its high prevalence in the population and frequent development in various diseases, which requires constant vigilance of doctors of any specialty. Nevertheless, at the present stage, the doctor's arsenal has enough diagnostic and therapeutic options for early detection and timely correction of sideropenic conditions.

Literature

L. A. Anastasevich, Candidate of Medical Sciences
A. V. Malkoch, Candidate of Medical Sciences
RSMU, Moscow

Hemoglobin deficiency in young children is a common abnormality. More than 70% of babies suffer from some degree of anemia. Anemia in children may be asymptomatic or present with characteristic symptoms. It depends on the degree of lack of hemoglobin and the stage of the disease. You need to know that anemia is not a primary disease and refers to secondary symptoms of various disorders in the body.

Causes

What is anemia and what causes it? Anemia is a lack of hemoglobin in the blood cells. Today, there are several types of anemia, the symptoms and treatment of which depend on the causes of the development of pathology. Most often, iron deficiency anemia is diagnosed in younger patients. In general, anemia in children occurs during the period of active growth. Such a deviation does not require medical treatment, and iron stores can only be replenished by adjusting the baby's diet. The development of anemia in babies under 1 year old is considered dangerous. After 6 months of life, with improper nutrition in the body of the crumbs, the reserves of this element run out, and with the development of a deviation, the baby may suffer from hypoxia. This often affects the physical and mental development crumbs. The consequences of neglected anemia in children can be mental, mental and physical abnormalities. With normal development in children under 6 years of age, the hemoglobin level should not fall below 115 g / l.

The main category of children with anemia in the first year of life are babies born with low weight, children from multiple pregnancies, premature babies and those who gain weight too quickly. However, the health of the mother during pregnancy can affect the well-being of the child. So if the mother had anemia of moderate and severe degree during the bearing of the baby, the child will also be born with this pathology. These are not all the reasons why anemia can develop in children.

Doctors consider the most common causes:

• congenital pathology.
• Artificial feeding.
• Overexpenditure of iron by the body during growth.
• premature birth.
• Pathologies in the mother during pregnancy.
• hemolytic disease.
• Frequent blood loss (for example, nosebleeds).
• Pathologies of the gastrointestinal tract.
• Violation of absorption and metabolism of iron.
• Pathology of the liver and kidneys.
• Chronic infectious diseases.
• Lack of vitamins.

In addition, the causes of anemia in children may lie in the fact that the hematopoietic system in babies is not yet perfect and any infections, stress, and even negative environmental factors can provoke iron deficiency. In order for the deviation not to turn into a severe form, it is necessary to take routine tests and carefully monitor the health of the child. Remember that the development of anemia in children, the causes, which may lie in hidden pathologies, should be identified in time. The success of treatment depends on timely diagnosis.

Symptoms

Symptoms of anemia in children are quite diverse. With a latent form, the disease can be almost asymptomatic, but attentive parents can still notice some points that should alert.

Common symptoms for children with anemia are as follows:

• Paleness of the skin.
• Poor condition of nails and hair.
• Increased fatigue.
• Capriciousness.
• Bad appetite.
• Enuresis.
• Frequent colds.
• Vertigo.
• Rapid pulse.

As a result of a general blood test, anemia is detected in a child if hemoglobin values ​​are below 115 g / l in children under 6 years of age and below 120 g / l in children over 6 years of age. It is important to establish the type of anemia, and identify the causes of its development. This is the only way to prescribe adequate treatment that will be effective for each individual child. Symptoms of anemia in children, which can be different, should always alert the mother. If your child has at least one of the manifestations of anemia, immediately go to the doctor.

Classification by reason

When interviewing parents, the doctor can already make a preliminary diagnosis, for what reason the baby has low hemoglobin in the blood. In modern practice, doctors use an anemia classification system that highlights the classic symptoms of a particular type of pathology. Anemia is divided into:

• Posthemorrhagic. This type of pathology arises from severe blood loss. A child can lose a lot of blood in a short time due to injuries, operations, intestinal bleeding. The classic symptoms of this type of anemia are shortness of breath, low blood pressure, and palpitations. On examination, pale skin is observed. Therapy in this case begins with stopping the bleeding.
• Hemolytic. Anemia in children of a hemolytic nature develops against the background of increased death of red blood cells. A blood test reveals a large amount of free hemoglobin. External symptoms are manifested by jaundice, enlargement of the spleen, general weakness. The hemolytic type of anemia is most often a hereditary defect.
• Hypoplastic. With this pathology, the maturation of blood cells of leukocytes, erythrocytes and platelets is impaired in a child. There is a decrease in the formation of blood cells. Most often, pathology develops against the background of intoxication with chemical elements or medicines. The causes of this pathology lie in a hereditary defect. Diagnosis is based on the results of a histological analysis of the bone marrow.
• Dyserythropoietic anemia. Pathology develops against the background of an insufficient number of red blood cells. This may be due to both violations in the process of destruction, and deviations in the process of cell division in the bone marrow. The symptoms of this pathology are very similar to the manifestations of hepatitis. Jaundice of the skin, the liver and spleen are enlarged, bone deformity occurs.
• Hypochromic. This type of anemia in children is the most common and occurs from a lack of iron in the body. Pathology is characterized by classic symptoms of anemia.
• Megaloblastic. This type of anemia is caused by a lack of vitamin B12 or folic acid. Most often, the pathology is hereditary. The clinical picture is characterized by disorders of the nervous and digestive systems, increased fatigue, enlargement of the spleen, and yellowness of the skin. Diagnosis is based on the results of bone marrow analysis.

Treatment

Treatment of anemia in children, especially the first year of life, is a necessity that can prevent the development of dangerous pathologies in a child in the future. Many parents underestimate the danger of anemia, and in fact, due to anemia, the baby can suffer significantly. Children with prolonged forms of anemia often have mental and mental abnormalities, they are smaller than their peers. Often at school, such children study poorly; they have problems with remembering information.

Behavior also leaves much to be desired, they are hysterical, capricious, and in the future become uncontrollable.

Most often, anemia in children begins to develop after 6 months. It is at this moment that the mother needs to more carefully monitor the baby. Don't miss your regular doctor's appointments and blood tests. If anemia is not hereditary, it is acquired as a result of malnutrition or large blood loss. Heavy bleeding cannot be overlooked, but the lack of nutrients in the food of children is a very common phenomenon. Most often, for anemia in children, treatment includes diet, physiotherapy and vitamin preparations.

If anemia is detected in a child, parents should arrange for the baby to special food, normalize the schedule of sleep and wakefulness, as well as ensure the reception of special medicines. When there is already an iron deficiency in the body, it is very difficult to fill it with food alone. Proper nutrition can maintain the level of vitamins in the body, and they will have to be replenished with pharmacy products.

Products

The diet for anemia in a child should be made by a doctor. It is important for children of the first year of life to introduce complementary foods rich in iron. For babies, the use of liver and meat purees, egg yolk, cereal porridge without milk is mandatory. If the child is bottle-fed, special iron-fortified formulas should be selected. It is advisable to prepare all complementary foods at home from fresh and healthy products.

Older children are recommended to eat a lot of beef, liver, greens, legumes and cereals. You also need to include in the children's diet as many vegetables, fruits, natural juices, dried fruits and seafood as possible. The child needs to be given iron-containing foods every day, while excluding milk from the diet. Vitamin C contributes to the absorption of iron, so there should also be a lot of it in the child's diet.

ethnoscience

AT traditional medicine there are also several effective recipes that can increase the level of iron in the blood. From anemia, you can prepare a vitamin mixture that will not only replenish iron stores, but also raise immunity, strengthen the heart and blood vessels, and also give vigor for the whole day.

You need to take equal portions of dried apricots, white raisins, black raisins, figs, walnuts, lemon and honey. Wash all the ingredients and grind in a meat grinder, pour melted honey, mix thoroughly. Put the mixture in a glass jar and refrigerate. Take in the morning 30 minutes before meals for adults 1 tablespoon, for children 1 teaspoon with a glass of water.

Nettle for anemia. To prepare the infusion, you need to take 2 tablespoons of nettle leaves and pour them with 1 liter of boiling water, cover with a lid. The infusion should cool down. Take 1 glass per day.

You can cook soups based on the infusion.

Dried fruits for anemia. All dried fruits are rich in their vitamin composition. If it is not possible to prepare a vitamin mixture with honey, the child can simply be given various dried fruits throughout the day. Usually, children who were not previously given sweets enjoy raisins and dried apricots with pleasure.

Prevention

Anemia is easier to prevent than to treat. If the pathology is not hereditary, it is very important for a child to eat right from birth. Studies have shown that children who are breastfed are much less likely to suffer from anemia. Mother's breast milk contains all the necessary nutrients in the required volume.

If you are breastfeeding your baby, do not forget that you should eat properly and varied.

After 6 months, as a preventive measure, you need to give the baby vitamin complementary foods. Despite the fact that there are a lot of different baby purees and juices on the market today, it is better to cook them at home from fresh products. Be sure to include meat in the baby's diet. It is in meat that the highest iron content is absorbed and it is better absorbed than from plant foods. In this case, the meat must be chosen correctly. The most iron-rich varieties are rabbit and veal.

It should be remembered that children's anemias are of different types. For this reason, self-treatment of this disease can lead to unpleasant consequences. All vitamin complexes and iron-containing preparations, as well as their form and schedule of administration, should be selected by a doctor. If your child has signs of anemia, contact the clinic. There, the baby will be given a blood test, the cause will be identified, and the doctor will tell you how to treat anemia in your particular case.

In contact with

Hemoglobin (it is denoted by the letter A), consisting of protein and trace elements that enter the body with food, is part of erythrocytes - red blood cells. Under the influence of oxygen, it oxidizes and gives color to the blood cell. If there is not enough hemoglobin in the baby's body, anemia develops.

Anemia in a child: a slow disease

Anemia develops slowly and imperceptibly, the first symptoms appear only when the deficiency is already quite large and it takes a long time to replenish it. Usually parents pay attention to the paleness of the skin, decreased activity of the crumbs, muscle weakness, slowing down of conditioned reflexes. If the child's skin becomes dry and flaky, and seizures appear in the corners of the mouth, you should also be wary. Crumbled teeth, lifeless, dull and brittle hair indicate a similar problem.

In most cases, the disease is detected by chance, for example, according to the results of a general blood test in a child at a routine medical examination or before vaccination. Diagnosis of anemia in a child consists of clinical manifestations and laboratory data. On examination, the doctor will definitely pay attention to the rapid pulse and low blood pressure of the little one. To confirm the fears, he will prescribe a biochemical blood test. The final conclusions are based on indicators of hemoglobin concentration, the number and volume of red blood cells, blood color and the level of liver and kidney enzymes in it.

Why is anemia in a child bad?

Hemoglobin has many functions, but the most important is that it retains oxygen in the body, accumulates it and delivers it to all organs. Oxygen starvation (hypoxia) can cause various diseases. Hemoglobin is unevenly distributed in tissues: approximately 2/3 is contained in erythrocytes, some is part of other proteins and some enzymes of the liver, spleen, etc. Hemoglobin is especially necessary for the normal functioning of the immune system; without it, it is difficult for the body to resist viruses and infections. And hemoglobin is also responsible for cleaning the body of carbon dioxide. It "catches" the exhausted oxygen from the tissues and directs it to the lungs, which take it out.

It is a fact
For normal development, the body requires many useful substances, each of them has its own tasks. Iron, vitamin B12 and folic acid are responsible for hemoglobin levels. Without them, it will not be possible to raise the indicator to the proper level.

There is an opinion that the level of hemoglobin in a child will not decrease if the baby eats meat, drinks pomegranate juice and walks a lot. In practice, such tactics do not always give positive results, because there are many more reasons for the development of hemoglobin deficiency in a child, and an unbalanced diet is only one of them. In diseases of the gastrointestinal tract, liver, kidneys, bone marrow, infectious processes, iron, supplied in sufficient quantities, is not absorbed and there is not enough hemoglobin in the body.

How to suspect anemia in a child?

Pale mucous membranes and skin, frequent stomatitis and colds, increased fatigue, and poor appetite allow suspecting anemia in a child. In babies of the first months of life, the norm of hemoglobin content is from 110 to 130 g per liter of blood. If the result is unsatisfactory, the child will be prescribed an iron preparation. For artificial babies, a doctor may recommend an iron-fortified formula. If a mother is breastfeeding a baby, it is also advisable for her to take a hemoglobin test and, if its level is lowered, start taking similar medications. Of the food products for lactating women, it is worth focusing primarily on meat: it contains the most natural iron. Meat dishes should be combined with fresh vegetables, berry sauces and freshly squeezed juices. They contain vitamins that help absorb maximum iron: group B, especially B12 and C. But dairy products, tea, coffee, cocoa, eggs, whole grain cereals simultaneously prevent the absorption of the mineral.

Doctor's advice
Anemia can develop not only in children at risk, but also in a healthy child. To prevent its occurrence, you need to monitor the level of iron in the children's diet.

What should I do if my child is anemic?

The body's need for iron is only 3.5 g per day. The faster the baby grows, the more iron it needs. And therefore, peanuts up to 3 years are more prone to anemia. The next peak of iron deficiency occurs at puberty. To prevent a lack of iron in a child, the baby must receive it every day with food in the required quantities. In this case, the mineral should be well absorbed in the intestines. The first condition is easy to meet if the peanut menu is balanced. The second is if you do not give the baby meat with those foods that prevent the absorption of iron. For these reasons, it is necessary to maintain at least a 20-minute interval between taking meals with a high content of iron and interfering with its absorption.

It is a fact
Every day with sweat, urine and other secretions, 1 mg of iron is excreted from the child's body. And the same amount enters it with food, absorbed in the gastrointestinal tract. Imbalance will lead to a deficiency of the mineral and a decrease in the hemoglobin level in the child.

What to feed a child with anemia?

If the child's hemoglobin level is non-critical, then the doctor may limit himself to recommendations for including foods with a high iron content in the diet. Products are divided into heme, supplying a lot of iron (meat, fish, eggs), and non-heme (most cereals, milk, vegetables, fruits). From the first group, the body "takes" up to 30%, from the second - only 7%. Since up to 90% of the baby's diet consists of products of the second category, it is difficult to manage with one diet - preparations containing iron, vitamins C, B12 and folic acid in the complex are required. The child can take drops, syrup, tablets; if urgent correction is required, injections are prescribed, in the most severe cases, blood transfusions are required, they are also blood transfusions or droppers. The choice of funds is the prerogative of the doctor, since only he can compare the characteristics of the course of the disease, the weight of the child and the tolerability of the drug. The course of therapy lasts 3-6 months. During the treatment period, it is necessary to conduct control studies: they will help determine the effectiveness of the measures taken.

Anemia in a child: a special case

If there is enough iron in the body and hemoglobin is low, the doctor will prescribe a complete blood count to examine the red blood cells. If they are enlarged, they will conduct a second test - a biochemical blood test, which can reveal a deficiency of vitamin B12 and folic acid. This anemia is called megaloblastic anemia and is less common. The disease has similar causes and is accompanied by persistent diarrhea. Treatment consists in replenishing the missing substances with the help of medicines and diet. If parents are serious about the recommendations of a specialist, then the hemoglobin level in a child will return to normal relatively quickly. And in order to avoid repeating the past, you will have to regularly take blood tests and monitor the nutrition of the crumbs.

Sometimes parents do not see anything wrong with the fact that there is a low level of hemoglobin in the decoding of a blood test. Although there are plenty of reasons for concern. If the child is still very young, anemia can cause a developmental delay or provoke some diseases.

Schoolchildren cease to study well and complain of rapid fatigue. In this case, the treatment of anemia will help restore the health of the child and save him and his parents from anxiety.

Anemia is a state of the body characterized by a low level of hemoglobin and a small number of red blood cells in the blood. In the people, anemia is also called anemia.

Hemoglobin is an important substance that contains iron, which is so necessary for the child's body. With its help, oxygen enters the tissues. Insufficient amount of oxygen causes cell hypoxia.

How does the number of red blood cells and hemoglobin depend on childhood

Childhood anemia most often occurs before the age of 3 years. This is due to the high sensitivity of a small organism to the aggressive effects of factors provoking the development of anemia.

As soon as a child is born, the body begins to actively produce red blood cells - erythrocytes. Their number changes with age both up and down.

Until the age of 6 months, the child retains the reserves of hemoglobin, which was given to him by his mother in the womb. After six months, active production of a substance that delivers oxygen to cells begins.

Another turning point is noted during the child's puberty. The body of a 12-year-old teenager begins to produce more red blood cells and, thereby, provokes an increase in hemoglobin. The dependence of the number of red blood cells and hemoglobin on childhood is presented in tables 1 and 2. By evaluating the data, one can see the described critical periods.

Table 1 - Change in the number of erythrocytes

Table 2 - Change in hemoglobin level

In addition, the data presented are influenced by past illnesses in childhood, malnutrition or improper artificial feeding.

Causes of the disease in the chest

There are many reasons for the development of anemia. Their appearance depends on the type of anemia diagnosed. Anemia can develop both due to minor factors, and to talk about the presence of severe pathological processes in the body.

Conventionally, the causes leading to a decrease in hemoglobin in the blood are divided into three groups:

• antenatal;
• intranatal;
• postnatal.

Factors that develop during a woman's pregnancy

The body of a woman carrying a fetus during the entire pregnancy actively transports iron into the womb. So for the newborn a kind of supply of matter is formed.

If a pregnant woman has some pathologies, it is quite possible that anemia will appear in the child with a violation of the iron transport system. Such diseases include:

• gestoses;
• placental abruption ahead of schedule;
• premature birth;
• anemia;
• pregnancy with twins or triplets;
• development of bleeding;
• chronic hepatitis.

Factors that occur during childbirth

Usually, the development of anemia in a newborn is provoked by a large blood loss of the woman in labor. Bleeding during childbirth can be caused by:

• detachment of the placenta before the term;
• insufficient processing of the umbilical cord residue;
• tying the umbilical cord too soon or too late;
• damage caused by obstetric instruments.

Other factors that appear during the development of the newborn

There are many types of postnatal factors. The causes of childhood anemia can be different. The main ones are:

• pathology of hematopoiesis;
• significant or frequent blood loss (nosebleeds, surgery);
• violation of the processes of iron absorption (rickets, cystic fibrosis, lactase deficiency);
• the development of allergic reactions on the skin;
• other diseases (pyelonephritis, leukemia, tuberculosis).

Existing types of anemia

Depending on what factors affect the appearance of anemia in a child, there are some types of this pathology. Based on this, appropriate treatment is prescribed.

Iron deficiency anemia

In the vast majority of cases, anemia in a child develops precisely because of the intake of an insufficient amount of iron. This is due to the constant development of the child's body, which requires the transportation of increased portions of iron into the cells. With insufficient consumption of iron-containing foods or preparations, iron deficiency develops.

Caused by a decrease in the level of porphyrins

Sideroahrestic anemia can be caused by a violation of the synthesis of one of the components of hemoglobin. This is due to an insufficient amount of protoporphyrin.

The development of this type of anemia is associated with some factors:

• Hereditary.

In view of the difficulties of inheritance, congenital sideroachrestic anemia affects predominantly the male sex.

• Acquired.

The development of the disease occurs due to lead poisoning or prolonged use of alcoholic products or certain specific drugs. Due to the presence of an excess amount of metal, the level of porphyrins begins to decrease. The appearance of anemia is influenced by the factor of being in harmful conditions, which include working with metal-containing dust or particles.

Treatment involves the complete removal of hazardous metal from the body.

Iron and vitamin deficiency

Dimorphic anemia is quite rare. It has in itself signs characteristic of both ordinary iron deficiency anemia and peridoxine deficiency. This is due to the presence of certain factors and diseases that provoke the simultaneous development of iron deficiency and a lack of vitamin B12.

Consequences of hematopoietic disorders

Hypoplastic, or aplastic, anemia has a number of characteristics that distinguish it from iron deficiency anemia:

• the process of bone hematopoiesis begins to be sharply inhibited;
• the quantitative level of adipose tissue is much higher than the content of hematopoietic cells;
• possible presence of hemorrhagic syndrome on the skin.

Usually, aplastic anemia provokes the development of various infections that give serious complications of the course of the disease.

Anemia due to insufficient vitamin B12

Pyridoxine deficiency anemia appears due to an insufficient amount of vitamin B12 in the child's body. The reason for this may be the pathology of the process of hematopoiesis. With the help of a clinical study in the blood, not only a decrease in the level of the vitamin is observed, but also an increase in bilirubin. To diagnose in time accompanying illnesses internal organs, the child is prescribed additional examinations.

hereditary

Thalassemia is considered to be a hereditary disease caused by abnormalities in the structure or process of hemoglobin production. Often the first symptoms appear at an early age. Visually, the disease can be recognized by a square head, a flattened bridge of the nose, narrow eyes and a large upper jaw.

When the disease occurs, the destruction of red blood cells, and iron begins to accumulate in the organs. Diagnosis of thalassemia is carried out even in the prenatal period. If at least one of the parents has a similar disease, a pregnant woman undergoes a series of diagnostic procedures in order to identify a hereditary disease in the fetus.

Anemia due to destruction of red blood cells

Hemolytic anemia can develop due to the presence in the child of diseases that provoke the breakdown of red blood cells. Diagnosis of this type of anemia is much more difficult than the detection of iron deficiency anemia.

The disease has specific symptoms that make doctors more likely to detect anemia and save the baby.

As a rule, hemolytic anemia develops from an early age. With a congenital disease, there is a lesion of the bone skeleton. The skin has a yellowish tint.

Stages of anemia

Manifesting, anemia has several stages of development. Each period has its own distinctive features and methods of treatment.

1. The period of development of anemia.

The reduction of iron stores in the cells begins, while the hemoglobin level remains relatively normal. Minerals obtained from food are no longer absorbed and do not affect the level of hemoglobin. Iron deficiency develops due to the inactivity of intestinal enzymes.

1. latent course of the disease.

The stage is also called as hidden. The reason for this is a decrease in the level of iron in the blood serum.

1. The period of pronounced activity of anemia.

Hemoglobin begins to decline, reaching critical levels. Along with this, the production of red blood cells decreases, and a lower level of red blood cells is seen in the blood.

Dr. Komarovsky talks about how you can find out about the level of hemoglobin, about the methods by which you can increase it.

Signs and symptoms of the manifestation of the disease

It is quite difficult to understand that anemia develops in a child without special laboratory tests.

However, there are common symptoms that indicate a decrease in hemoglobin.

• Pale skin.

Along with this, pallor of the mucous membranes may be observed. Nails begin to break for no reason, teeth are attacked by caries. It is possible to change the taste preferences of the child.

• Emotional changes.

The child becomes easily excitable, irritable. This is due to increased fatigue of the body against the background of iron deficiency. Parents may notice that the child begins to lag behind in school or physical activity.

• Cardiovascular syndrome.

The child may have low blood pressure, palpitations, or shortness of breath.

• Decreased protective functions of the body.

The symptom is manifested in the frequent morbidity of the child.

• Internal organs such as the liver and spleen increase in size.
• development of enuresis.

The manifestation of anemia in children in the first year of life

Iron deficiency in young children can provoke various complications, up to mental and physical developmental delay. If you notice symptoms of anemia or detect a reduced level of hemoglobin, you should immediately seek help from a specialist.

In a child under one year old, anemia can manifest itself in the following:

• against the background of pallor of the skin, dry mucous membranes are noticeable;
• the constant appearance of stomatitis or conjunctivitis;
• decreased or absent appetite;
• frequent regurgitation, sometimes in copious masses;
• restless sleep.

Based on the fact that the listed symptoms may have other diseases, the diagnosis of anemia in infants is very difficult. The main method remains the delivery of a blood test for hemoglobin.

A feature of the development of anemia in a child up to a year old is his ability to restore iron stores by six months. In the absence of such sources, hemoglobin begins to fall. The immune system becomes weak and the body vulnerable to infections. Timely diagnosis of anemia will help restore the health of the child and not put him at risk.

Anemia and premature babies

In children born prematurely, anemia occurs quite often. The severity of the disease directly depends on the gestational age of the child. Due to some features in a premature baby, hematopoiesis ends already being born.

In addition, in children who were born prematurely, there are changes in the shape of red blood cells and a reduction in their life expectancy.

There are many reasons for the development of anemia in a premature baby. This can be either weakness and incomplete development of the body, or complex childbirth or a hereditary factor.

Anemia in premature babies begins its manifestation at the end of the first month of life. By 4 months, the peak of the development of the disease is observed. With timely treatment, the child recovers by 6-7 months.

If severe anemia is diagnosed, a specialist may recommend a blood transfusion. This procedure will help to increase the number of red blood cells in the blood in a minimum period of time.

Diagnosis of anemia

Diagnosing anemia in a child is a process consisting of several stages. Each of them has its own characteristics, but the most important of them is laboratory research. The combination of test results and the collection of anamnesis allows you to accurately diagnose the child and prescribe adequate treatment.

Initial Poll

The most important questions that concern the doctor in making a diagnosis are:

• how balanced the child's nutrition is and what kind of food he receives (artificial or breastfeeding);
• the presence of cases of bleeding (heavy menstruation in girls, bleeding gums or nasal bleeding);
• whether there were cases of spleen removal in the family or some specific diseases.

Patient examination

First of all, the doctor examines the child's skin and mucous membranes. Next, the abdomen is palpated to reveal a pathological increase in the size of the internal organs. Be sure to measure blood pressure, heart rate, palpable lymph nodes.

Clinical researches

With the help of a general blood test, developing anemia can be detected. At the age of one year, this study is carried out several times to prevent the development of anemia or to take appropriate measures.

In the transcript, you can see some important indicators and their meanings:

• the number of red blood cells;
• hemoglobin level and its amount in red blood cells;
• reticulocytes;
• quantitative content of other blood elements.

The norms of the amount of hemoglobin in children according to the results of a blood test and critical values ​​\u200b\u200bcan be seen in table 3.

Table 3 - Norms of hemoglobin indicators depending on the age of the child

Other examinations

The subsequent examination of the child is associated with the identification of any abnormalities in health. By ultrasound, the degree of enlargement of the internal organs is determined. Endoscopy can confirm the presence of bleeding in the gastrointestinal tract or reveal pathological conditions. Conducting an ECG will give an idea of ​​​​the work of the heart. In addition, the doctor may prescribe an X-ray of the lungs or a CT scan.

Medical treatment

To cure anemia in a child, the pediatrician prescribes the intake of drugs containing iron. Treatment is long, reaches in some cases 3 months. Medicines have different forms of release for children of different ages.

• Drops.

They are used mainly for young children, starting from the moment they are born. The advantage of such iron-containing preparations is the ability to add drops to a bottle of juice. Liquid medicines are convenient to give to a child who is not yet able to swallow a pill. Usually pediatricians prescribe "Maltofer" or "Gemofer".

• syrups.

Starting from the age of 2, a child can be treated with iron syrup. Precise dosing of the medicine with a measuring cup allows you to give even the smallest doses to children. Of the drugs on the market in the form of a syrup, FerrumLek and Ferronal are considered the most popular.

• Pills.

Each capsule of the iron-containing drug is covered with a protective shell. Such drugs exclude the staining of tooth enamel in a yellowish tint. Tablets are prescribed for older children: "FerrumLek", "Aktiferrin", "Hemofer".

Along with medicines containing iron, herbal medicine may be recommended for a child. This is primarily due to a possible disruption of the digestive system.

diet diet

In addition to taking iron supplements, a special diet is recommended. If the baby is not yet a year old, then grated vegetables, fruits, juices and mashed meat should be included in his diet. Artificialists need to change the usual milk formula to iron-fortified.

Older children are prescribed a diet, they are given sea fish fillets, liver, red low-fat meat, and beans. Vegetables and fruits are more useful to eat fresh: salads, juices and smoothies.

Pomegranate juice is rich in iron content. Vitamin C helps to absorb iron, so it is advisable to include rosehip decoction in the diet.

Prevention

In order to prevent the development of anemia in time, you should regularly visit a pediatrician and take the necessary tests. Under special control are children born prematurely or with low birth weight.

Prevention begins, first of all, with properly organized nutrition. Food should contain useful substances and minerals that contribute to the normal functioning of blood formation.

Do not neglect walking on the street. You can give the child a massage, accustom to hardening the body, and also set the daily routine.

Anemia that occurs in a child is considered not so rare. The lack of a favorable environmental situation, unpredictable complications during childbirth or the manifestation of diseases adversely affect children's health. A decrease in hemoglobin affects the quality of life: the child becomes restless, stops doing well at school, and feels unwell.

Only qualified help will relieve anemia and save the child's body from the attacks of various diseases, which are caused by iron deficiency.

The main thing to remember is that hemoglobin cannot be increased by eating alone. Only systemic treatment and prevention will give an excellent result.