Iron Deficiency Anaemia In Children

Iron deficiency anaemia is the commonest nutritional anaemia in childhood. Causes include inadequate dietary iron, rapid growth, excessive cow milk intake, chronic blood loss, parasitic disease and malabsorption.

Iron deficiency can impair neurodevelopment even before severe anaemia develops.

• Pallor
• Fatigue
• Irritability
• Reduced exercise tolerance
• Tachycardia
• Poor appetite
• Pica
• Poor concentration

Severe anaemia may cause tachypnoea, cardiac failure or shock.

Typical findings include:

• Low haemoglobin
• Low MCV and MCH
• Increased red cell distribution width
• Low ferritin
• Low transferrin saturation
• Increased total iron binding capacity

A low ferritin strongly supports deficiency. A normal ferritin does not exclude it during inflammation.

Blood film typically shows microcytic hypochromic erythrocytes.

• Give elemental iron 3 mg/kg PO once daily for uncomplicated iron deficiency anaemia. Doses up to approximately 6 mg/kg/day may be used in more severe deficiency depending on formulation and protocol.

• Continue treatment for approximately 3 months after haemoglobin normalizes to replenish iron stores.

• Haemoglobin should begin increasing within approximately 2 to 4 weeks if diagnosis, adherence and absorption are adequate.

• Treat the cause, including dietary deficiency, excessive cow milk intake, gastrointestinal blood loss or helminth infection.

• Transfusion is reserved for severe symptomatic anaemia or cardiovascular compromise, not simply a low haemoglobin in a stable child.