Common Causes of Anemia
Anemia can be caused by various factors, all reliant on the number of red blood cells in the blood. For example, if a child does not get enough iron with food or during pregnancy, they may develop anemia in the early years of childhood (Khan, 2018). Here, iron-deficiency anemia (IDA) develops due to low consumption of iron-rich foods, breast milk from an anemic mother, or lack of other supplements. The second potential cause is underlying illnesses that raise the destruction of red blood cells. A child may also have sickle-cell anemia – an inherited condition (Khan, 2018). Finally, blood loss is another common way of developing anemia. In adolescents, menstrual bleeding can be a cause of anemia. Adolescents require higher iron levels due to growth spurts, and blood loss can exacerbate this problem.
Incidence of IDA in Childhood
Iron-deficiency anemia (IDA) is the most common type of anemia globally. It is estimated that approximately 25% of the population have some variety of anemia, and about half of them have IDA (Andriastuti et al., 2020). In the United States, about 3% of infants have IDA, while other countries report rates between 3% and almost 50% (Andriastuti et al., 2020). For some low-income countries, such as Indonesia, the studies show that about 18% to 28% percent of adolescents and children are anemic (Andriastuti et al., 2020). Therefore, one can see that incidence of IDA is high – in some cases, 1 in 4 children are affected by iron deficiency and low red blood cell count.
Risk of IDA
As children require significant iron levels to support their growth, they are at risk of developing IDA. Premature birth, insufficient iron in the diet, and lead in blood can lead to anemia (Khan, 2018). Therefore, children living in low-income households or those who live near lead paint, contaminated water, and other sources of lead are at a higher risk of IDA. Moreover, teenage girls with heavy periods are also at the greatest risk. They may lose more blood than is required to support their health.
Findings in Children with IDA
The subjective findings include changes in behavior; the child is likely to report loss of appetite, irritability, and tiredness. Children with anemia often have paler skin, and some also develop koilonychia – spoon nails (Khan, 2018). Findings in the cardiovascular system include tachycardia and cardiomegaly (Khan, 2018). The gastrointestinal system is also affected – inflammation of the tongue and stomatitis are among the possible findings (Khan, 2018). In extreme cases, symptoms may include shortness of breath, swelling in hands and feet, and restless leg syndrome. Pica is another finding – low iron levels can compel children to eat non-food items, such as dirt, ice, paper, and more.
Findings in Adolescents with IDA
The signs for IDA in adolescents are similar to those for children. Restlessness and faster exhaustion are common, as well as paler skin and elevated heart rate (Khan, 2018). In teenage girls, other symptoms include cold intolerance and fatigue (Khan, 2018). Moreover, some adolescents may experience febrile seizures, restless leg syndrome, and difficulty breathing or holding one’s breath. Jaundice, an enlarged spleen, and urine discoloration (to dark color) are among the findings in teenagers with IDA. Other subjective symptoms described in the previous paragraph also apply as teenagers may seem increasingly moody.
Differential Diagnoses
IDA is a type of anemia; therefore, other varieties of this condition can be considered its differential diagnoses. According to Jahangiri et al. (2020), thalassemia is one of the disorders that is difficult to distinguish from IDA. It is an inherited disorder that causes low hemoglobin levels. The symptoms of thalassemia are similar to IDA, including fatigue, pale skin or jaundice, and dark urine. Other differential diagnoses include lead poisoning, anemia of chronic disease, and autoimmune anemia (Jahangiri et al., 2020). These conditions are distinguished from IDA with the help of diagnostic testing. For example, IDA is characterized by low levels of ferritin, increased total iron-binding capacity, increased serum transferrin receptor, and decreased serum iron in the blood (Jahangiri et al., 2020). The first test is usually enough to support or refute the diagnosis, and other diagnostics can be used in unusual cases.
Management of IDA in Children
The primary strategy for managing IDA in children is finding and eliminating the underlying cause of anemia. For example, if the child does not get enough iron in the diet, diet changes and supplements are suggested. Meat products are an essential addition to one’s meals, as they are a source of iron (Khan, 2018). Other foods include eggs, legumes, green vegetables, and some types of fruit. However, if the child does not want to eat certain food categories, then parents and guardians may use iron-fortified products that are appealing to the child. Supplements of iron and folic acid are necessary as they can quickly raise the level of iron in one’s blood.
Management of IDA in Adolescents
Similar to children, adolescents need to increase their intake of iron. A change in diet can help this process, but it is not enough to help growing teenagers sustain growth. Separate iron supplements are necessary to treat IDA – they cannot come in the form of a multivitamin as the dose is insufficient (Mantadakis et al., 2020). Moreover, adolescents should decrease the consumption of milk and drinks with caffeine as they lower the absorption of iron and increase their intake of vitamin C (Khan, 2018). Overall, dietary changes and supplements can help resolve a case of IDA.
References
Andriastuti, M., Ilmana, G., Nawangwulan, S. A., & Kosasih, K. A. (2020). Prevalence of anemia and iron profile among children and adolescent with low socio-economic status.International Journal of Pediatrics and Adolescent Medicine, 7(2), 88-92. Web.
Jahangiri, M., Rahim, F., Saki Malehi, A., Pezeshki, S. M. S., & Ebrahimi, M. (2020). Differential diagnosis of microcytic anemia, thalassemia or iron deficiency anemia: A diagnostic test accuracy meta-analysis. Modern Medical Laboratory Journal, 3(1), 16-29. Web.
Khan, L. (2018). Anemia in childhood.Pediatric Annals, 47(2), e42-e47. Web.
Mantadakis, E., Chatzimichael, E., & Zikidou, P. (2020). Iron deficiency anemia in children residing in high and low-income countries: Risk factors, prevention, diagnosis and therapy.Mediterranean Journal of Hematology and Infectious Diseases, 12(1), e2020041. Web.