Is your child irritable and tired? While every parent knows the terror of a cranky, overtired child, in some instances more may be going on. If your child is dizzy, lightheaded or pale, he or she might be anemic, and you should consult a doctor.
Anemia is defined as a low number of red blood cells or low hemoglobin when compared to normal values for the child’s age. The cutoff value of anemia changes according to the age of the person, but 10 grams of hemoglobin or less is always considered anemia. Red blood cells, and the hemoglobin they contain, bind and deliver the oxygen we breathe in to all our body, and then bind carbon dioxide from the tissues, which will come out when we exhale. Therefore, not having enough hemoglobin or red blood cells will impact oxygen delivery. Anemia is detrimental to your child’s health in many ways. For instance, children who are chronically anemic are at risk of developing learning difficulties due to a subtle brain injury.
Babies are normally born with high hemoglobin concentration, but they will have an expected decline within the first two months of life due to rapid growth and other factors. This decline in hemoglobin is more pronounced in premature babies. The hemoglobin will stabilize in children after 2 months of age. It is very important that children have adequate nutrition in order to prevent anemia.
For a 1-year-old, the most common cause of anemia is nutritional from iron deficiency (IDA), and it occurs in about 3 percent of infants. It is important that infants consume a diet rich in iron. During childhood and adolescence, the most common causes of IDA are nutritional or related to blood loss (for example, girls with heavy menstrual periods). Some foods that contain abundant iron are liver, beans, tofu, pork, beef, cereals, spinach, prunes, figs and watermelon. In case of IDA, iron supplementation prescribed by a doctor should resolve the anemia. Other evaluations may be required depending on the child’s history or physical examination.
However, not all children who are anemic will have IDA. Other causes of anemia are acute or chronic infection or inflammation, bone marrow diseases that will suppress or limit the capacity to produce blood cells, or other acquired or genetic conditions like sickle cell anemia. Even a common cold can temporarily decrease the hemoglobin level slightly.
Anemia may be caused occasionally by serious conditions like leukemia or other forms of cancer. Although a rare cause of anemia, leukemia occurs in three to five in 100,000 children a year in the United States. Leukemia is a life-threatening but curable disease in most cases, especially if the child has acute lymphoblastic leukemia or ALL. Approximately eight out of 10 children with ALL will be cured of their disease. The treatment of leukemia requires specialized care by a pediatric hematologist-oncologist, and other symptoms generally present are fever, body aches, easy bruising or bleeding.
Another cause of anemia is sickle cell anemia, a commonly inherited disorder caused by a hemoglobin mutation, leading to the so-called hemoglobin S or sickle hemoglobin. If your child was born in the United States, he or she was screened for sickle cell anemia at the time of birth. Sickle cell anemia affects one in 500 African Americans and one in 36,000 Hispanics. The carrier state or sickle cell trait is much more frequent: one in 12, or 8 percent, of African Americans have sickle cell trait. The prevalence of sickle cell trait is 3 percent among Cubans, 10 percent among Jamaicans and 8 to 12 percent among Haitians. People with sickle cell trait are not expected to be anemic. In individuals with sickle cell anemia, changes in the hemoglobin S will cause red blood cells to turn into a sickle or new moon shape, resulting in red blood cell breakdown and anemia. In addition, the sickled red blood cells are stiff and may obstruct small blood vessels, causing lack of blood flow and pain. Children with sickle cell anemia are also prone to infections, especially those caused by a bacteria called pneumococcus or streptococcus pneumonia. Penicillin is indicated twice a day in children less than 5 years old in order to prevent infection, besides being current in childhood immunizations.
Children should be evaluated by a doctor on a regular basis. The American Academy of Pediatrics recommends screening for anemia between the ages of 9 and 12 months with additional screening between the ages of 1 and 5 years for patients at risk. Some children at risk are premature and low birth weight infants, infants with history of prolonged stay in the neonatal unit, use of noniron-fortified formula in the first year of life, history of blood loss or chronic infections, recently immigrated children, exclusively breastfed infants with no or limited iron supplementation, children who had early introduction of cow's milk, and other social risk factors.
As a parent, you are the most qualified to know how your child feels. If your child feels tired or looks pale, it is important to see his or her doctor for a checkup and a complete blood count.
Dr. Ofelia Alvarez is medical director of the pediatric sickle cell program at UHealth — University of Miami Health System. For more information, call 305-243-0846 or visit UHealthSystem.com/patients/pediatrics.