Anaemia

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When to see the doctor

Take your child to the doctor if: 

• you suspect that your child may be anaemic because they are very pale
• your child is irritable, lethargic and drinks large volumes of milk at the expense of solids
• you want additional information about what to feed your baby.

What causes it?

There are three main causes of anaemia. By far the most common cause in Australian children is a deficiency or lack of iron in the body. Iron is essential for the formation of haemoglobin, the part of the red blood cell which carries oxygen around the bloodstream. Far less common causes of anaemia are decreased production of red blood cells (aplasia – for example, in certain chronic diseases), or excessive destruction of red blood cells (haemolysis – for example, in some acute severe infections).

Iron deficiency in younger children is most often due to inadequate iron in the child's diet. Normally a baby has enough iron stores from their mother to last for the first six months of life, although if they were born prematurely or have been sick, the stores will be exhausted before then. After that they require iron to be part of their diet. Usually at around six months of age, the baby is introduced to solids such as cereals, vegetables, eggs, and later on, meat, all of which contain iron. However, babies who are on cows’ milk and who drink excessive quantities often have insufficient iron in their diet. Cow’s milk is a poor source of iron. In addition, if a baby drinks too much milk their appetite for solids is diminished. This problem rarely occurs in breastfed babies, or those who are on formula feeds (because these contain iron).

Older children may have iron deficiency as a result of a rapid growth spurt, or heavy periods in pubertal or adolescent girls.

What are the symptoms?

The child with anaemia may appear very pale. A toddler may exhibit lethargy, but this may not be obvious, given their usual high energy levels. Some babies and toddlers with iron deficiency are irritable and difficult to manage. Older children may be tired, have poor appetite and difficulties concentrating at school. If the anaemia is caused by something besides iron deficiency, then specific features of that condition may be present.

Is there a test?

Investigations are essential in any child with anaemia to find out its cause. Usually blood tests are all that is necessary, but sometimes other tests are performed as well.

How is it treated?

The treatment of anaemia depends on its cause. If it is due to rarer conditions associated with aplasia or haemolysis, then this is investigated and treated appropriately. Iron deficiency anaemia often requires iron supplements to be given by mouth, because it is very difficult to replenish iron stores by changing the child's diet alone. Only in rare cases of anaemia will a blood transfusion be required. All children with iron deficiency need to be placed on a balanced diet with adequate iron intake. This usually means avoiding cow’s milk in the first 12 months of life, cutting down on milk in toddlers and older children, and increasing the amount of iron-containing foods, such as spinach, meat and eggs.

Iron-rich foods include:

• iron-fortified infant milk formulas
• iron-fortified cereals
• legumes (such as lentils and beans)
• meat (red meat, chicken and fish)
  egg yolk
• green vegetables
• crushed sesame seeds (such as tahini, halva).

Iron supplements may turn stools black or grey and cause constipation.

How can I prevent it?

Iron deficiency anaemia can mostly be prevented by making sure that your child has a balanced diet after the age of six months. Most health professionals now advise against giving cow’s milk to babies younger than 12 months of age. Your local maternal and child health nurse or doctor can give you specific information about nutritional intake.

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