Iron deficiency anemia in children aged 12-24 months

Anemia

"Iron deficiency anemia is the most common form of anemia," (Brody 2008; "Iron Deficiency Anemia" n.d.). The population most at risk for developing iron deficiency anemia is babies between the ages of 9 and 24 months. Pregnant women and older children are also impacted by iron deficiency anemia. Anemia is a potentially chronic condition that can affect the child's physical and cognitive development, which is why it is crucial to monitor infant blood. Iron deficiency anemia is almost always related to dietary intake of iron, intestinal infections, or viral infections. The disease is also almost always preventable.

"All babies should have a screening test for iron deficiency" between 12 and 24 months of age; whereas babies born prematurely may need to be tested even earlier ("Iron Deficiency Anemia n.d.). Iron deficiency anemia is caused in part by the early introduction of cow's milk before the age of 12 months. Breast milk and iron-fortified formula can reduce the infant's risk of developing iron deficiency anemia. Iron is absorbed readily from breast milk, whereas cow's milk inhibits the absorption of iron in the baby's body. Infants absorb about 10% of the iron they eat, but absorb three times as much iron from breast milk (Brody 2008).

Consumption of cow's milk, especially when cow's milk replaces breast milk, is empirically implicated in some of the secondary precursors to iron deficiency anemia such as intestinal infections. "Cow's milk also can cause problems in the intestine that lead to blood loss and increased risk of anemia," (Brody 2008). "Cow's milk also can cause the intestines to lose small amounts of blood," ("Iron Deficiency Anemia n.d.). This is because cow's milk actually "irritates the lining of the intestine, causing small amounts of bleeding. This slow, gradual loss of blood in the stool -- combined with low iron intake -- may eventually result in iron deficiency and anemia," (KidsHealth n.d.). For this reason, iron-foritfied infant formulas are a preferable substitute for breast milk, if a substitute is required for medical reasons.

Socio-economic factors are invariably implicated with iron deficiency anemia, with low-income families particularly at risk (Tympa-Psirropoulou, Vagenas, Dafni, Matala & Skopouli 2008; Marotz 2009). Awareness of the problem has led to a decrease in prevalence of the problem of iron deficiency anemia in infants, although even in the developing world the incident level remains alarmingly high. In one region of Greece, for example, almost ten percent of infants aged 12-24 months demonstrated the presence of iron deficiency anemia (Tympa-Psirropoulou 2008).

Marotz (2009) points out related factors that may predispose populations at risk for fostering iron deficiencies infants. Nutrition issues are generally interrelated. For instance, a "lack of interest in food may further compromise the child's intake of iron," (Marotz 2009, p. 12-13). This suggests that there is a cyclical relationship between wellness and nutrition. Nutrition ensures a healthy appetite, which in turn means consuming nutritious foods. Consuming nutritious foods helps to stimulate that healthy appetite, thus leading to increased consumption of essential nutrients. The reverse is also true, with poor nutrition paving the way for reduced appetite and causing further nutritional deficiencies as well as possible disease.

The first step towards reducing prevalence of a preventable problem like iron deficient anemia is recognizing the problem exists. Blood screening for infants should be performed as a matter of course, especially among at-risk populations such as in low-income households. Second, pregnant mothers should be coached about the benefits of breast feeding as it relates to iron and other nutrients. Third, new mothers should be aware of the quantity of iron intake in their infants and make adjustments to diet if necessary.

"Babies are born with iron stored in their bodies. Because they grow rapidly, infants and children need to absorb an average of 1 mg of iron per day," ("Iron Deficiency Anemia n.d.). According to Brody (2008), "Babies are born with about 500 milligrams (mg) of iron in their bodies. By the time they reach adulthood they need to have about 5,000 mg."

Tympa-Psirropoulou et al. (2008) outline the three stages during which iron deficiency anemia develops in infants. First, iron stores in the body become gradually depleted. "Iron is an essential part of hemoglobin, the oxygen-carrying protein in blood," (Brody 2008). This first stage is sometimes called the pre-latent iron deficiency stage. The second stage is the latent iron deficiency stage, at which "the level of serum iron starts decreasing in parallel with an offsetting increase in siderophylin synthesis," (Tympa-Psirropoulou et al. 2008). Finally, the third stage is full onset iron deficiency anemia.

Once iron deficiency anemia has been identified in the infant, the problem can be corrected by careful supplementation. If the infant is being breast fed, the mother may need to increase her intake of dietary iron by consuming iron-rich foods such as "raisins, meats (especially liver), fish, poultry, egg yolks, legumes (peas and beans), and whole-grain bread," (Brody 2008). Dairy product intake should be minimized, because milk interferes with iron absorption in the mother as well as the baby. Iron supplements may also be indicated, especially for breastfeeding mothers "because diet alone rarely supplies the needed amount," (Brody 2008). The infant diagnosed with iron deficiency anemia should be given breast milk as well as infant formula specially designed to include iron supplements. Prune juice and infant cereals are also recommended, but cow's milk is to be avoided.