IRON DEFICIENCY

PART 2

Written by Dr Nické Theron, Pediatrician.

Iron deficiency anaemia occurs when the iron stores are so empty that there is not enough iron to make proper new red blood cells. The new red blood cells are thus fewer, smaller and paler and cannot carry oxygen effectively. Your body will always prioritize the available iron to first be used in the red blood cells, but iron has many other functions in the body (see previous post). So by the time that there is iron deficiency anaemia, the brain especially has already suffered from the lack of iron.

This is a sneaky disease because there are almost no symptoms initially. It is thus important that your doctor asks about the risk factors for developing iron deficiency during well-child-visits.

Babies and toddlers between the age of 6months to 3years have an especially high risk to develop iron deficiency anemia. The American Association of Pediatrics recommend that all children should be screened between 9-12 months of age because of the serious effects it has on long term neurodevelopment. Several studies show that the delays in development improves with treatment, but does not normalise completely.

The most common cause of iron deficiency is insufficient intake (see previous post for tips on prevention). Other causes could be blood loss from the gut, specific syndromes where iron is not absorbed from the gut or chronic inflammatory diseases.

Symptoms of Iron deficiency anaemia:

Mild:

  • No specific symptoms
  • Iron deficiency could lead to behavioural changes in your child that is sometimes difficult to pin-point eg. children become more wary, hesitant, solemn, unhappy, keep closer to their mothers.
  • Restless leg syndrome, breath holding spells, sleep disturbances, short attention span, learning difficulties have also been seen to improve when iron deficiency was treated.
  • Pica : an intense craving for weird non-food items such as clay, dirt, chalk, soap, paper, raw rice or ice (pagophagia). No one knows how this works, but it responds very well to iron supplementation.
  • Poor growth

Severe:

  • Pallor (seen especially around the eyes, in the mouth, the nails and on the palms/soles)
  • Severe tiredness and loss of interest in otherwise fun activities
  • Irritability
  • Poor appetite, sores in the corners of the mouth, painful tongue
  • Fast heartbeat, heart failure, fast breathing.
  • Other complications associated with iron deficiency anaemia: Febrile seizures (although no relational cause could be found, several studies have found that children with febrile seizures are more prone to be iron deficient). Iron deficiency also causes paralysis of some parts of the immune system.

If your doctor suspects iron deficiency anaemia blood tests will be the next step to confirm. A hemoglobin or full-blood count and ferritin count will be enough. Treatment with Iron supplements will be started and the effect on the red blood cells will be evaluated after one month of treatment. If there are no response further investigations should be done for other causes of the anemia.

Treatment of iron deficiency anaemia

Ferrous sulphate 3-6mg dly (can be given once a day or in divided dosages.
The best absorption of iron happens when you give it with orange juice (or other juice high in Vitamin C as this improves absorption) in between meals. Foods that can block absorption of iron are dairy, eggs, tea or coffee, whole-grain breads and cereals / bran.

Iron supplements are notorious for having many side effects. However if you start at a low dose and slowly increase it, and give the iron with meals most children tolerate it quite well. Remember to give the drops at the back of your child’s mouth or give it mixed in juice with a straw. Some iron supplements may stain the teeth, but this can be removed by brushing with baking soda (talk to your dentist first). There are many different iron formulations of which some are better absorbed/better tolerated, but this also comes with a significant price increase. In the end the most important thing is that your child drinks the supplement. (Studies show no difference in the end-result for different formulations).

VERY IMPORTANT: Treatment for iron deficiency anaemia should be given for at least 3months, even if the blood count normalises before that. Remember that the body will use any available iron for the red blood cells first, and then the stores still need to be filled to prevent future problems.

Dietary advice

It is important that your child’s diet is also adapted to include more iron rich foods. It is adviced that they should eat at least 2-3 iron rich meals per day. Remember that the iron in animal products is absorbed better and thus you need to eat bigger quantities of plant-based iron to absorb the same amount.

Some foods that are high in iron include:

  • Meat – red and white. Liver is especially high in iron.
  • Other animal sources: Eggs (especially the yolk), fish
  • Dried fruits: raisins, apricots
  • Green leafy vegetables
  • Dried beans and lentils
  • Oats, other grains
  • Soybeans

I hope you now feel more confident in the whys and hows of iron deficiency. There are still so many ongoing studies and new developments with regards to the influence and treatment of different neurodevelopmental diseases such as autism and ADHD that I am sure this is a topic that we will still hear a lot about!

Resources

  1. Ozdemir N; “Iron deficiency anemia from diagnosis to treatment in children”; Turk Pediatri Ars; 2015 Mar; 50(1): 11-19
  2. http://www.uptodate.com
  3. https://www.mayoclinic.org/drugs-supplements/iron-supplement-oral-route-parenteral-route/description/drg-20070148

TRIPPE TRAPPE TONE

Ek’s seker ek hét gekyk waar die eerste trappie is. Ek’s amper 100% seker…

Hierdie mamma het heel Vrydag soos ‘n absolute vrot ma gevoel! Ek het met baba en al by ons boonste verdieping se trap afgeval. Darem net tot in die helfte van die trap…maar nogsteeds… 😬 Eina.

Met my baadjie onder die een arm, dummy & Telement in die hand, selfoon in die gatsak en baba op die heup, het ek aan die bopunt van die trap gestaan en vlugtig afgekyk. Ek was haastig. Ek misgis toe die tweede trap vir die eerste een, en daar steier ek vooroor, met enkels wat swik en voete wat skraap, soos ek probeer om vastrapplek te kry! Toe ek die teëls sien nader kom, en ons 2 aanhou gly, besef ek ons ontmoeting met die grond is onvermydelik. Ek probeer vir boetiebaba nader trek, maar met die momentum (en sy 10kg lyfie) “ka-plaks” ons boude-eerste op die harde teëltrap. Ek kreun, en boetie snak na sy asem – toe begin hy hartverskeurend huil. Gelukkig hou ek hom steeds vas (hy het genadiglik nie uit my arms geglip nie!) en alhoewel hy opsigself ‘okay’ lyk, kan ek hoor hy’s in pyn. Ek gil histeries vir my man om te kom help, en soos hy vir baba uit my arms tel, voel ek my eie seer: my elmboog, my linkerboud, my enkel (díé het alreeds ‘n golfbal-swelsel aan die vorm).

Ons uitstappie na Ongevalle en X-strale bevestig: geen gebreekte/gedislokeerde bene. Dankie, Vader. My enkel is net sleg verstuit. Maar boetiebaba het ‘n diep sny onder sy 3de toontjie… Só wag ons toe vir die chirurg wat hom heelmoontlik teater toe sal moet neem vir narkose en steke…

Die chirurg kom sien ons toe ‘n paar uur later in die kindersaal (genade, maar dis sleg om ‘n kind – wat nog te sê van ‘n borsvoedende baba – nil per mond te hou! Ek’t as dokter-mamma beslis nuwe perspektief en empatie bygekry). Steke is toe nie nodig nie! Ons kan sy voetjie konserwatief met verbande behandel – halleluja!

Oudste, met sy klein hartjie en kinderlike geloof, het by die huis al vir mamma en boetie se voete gebid. Pappa noem na die hele gedoente hoe hy tóé al gesien het hoe die voetjie se swelling sak…

Boetiebaba se naam-betekenisse het in hierdie (kort) 7 maande vir my werklik “lewendig” geword: Kampioen en God is genadig. Deur al die “trials & tribulations”…deur septiese skok en breinvliesontsteking en brongiolitis…en sy ma wat heel simpel was om nie aan die trapreëling vas te hou nie… Hy is ‘n dapper klein mensie & God is altyd genadig.

TANTRUMS & TAAI TOFFIES

“Nee, Mamma moet. Mamma moet by my lê! Nie Pappa nie. Mamma!!!”

Só kerm-huil-skreeu my groot-oog amper-3-jarige kabouter net voor slaaptyd oor wie hý besluit het vanaand by hom moet lê tot hy na Droomland weggevoer word…

Dis al weer een van dáái dae. Daai hóógs uitdagende dae: van verseg-om-my-middag-slapie-by-die-skool-te-vat-en-nou-is-ek-totaal-verby-moeg-en-aaaaaalles-is-‘n-stryd!

Moet my nie verkeerd verstaan nie. Ek is ontsettend lief vir my 2 seuntjies. Maar party dae voel dit asof my geduld en kreatiewe-redenasie-vermoeëns tot die uiterste beproef word! Veral met Oudste (Boetiebaba praat (gelukkig?) nog nie terug nie, maar gil net in sy skril stemmetjie as hy gehóór wil word).

Terug by vroeër vandag:
Die groen plastiek-eetlepel móés eintlik blou gewees het, Rupert het sy hand gelek😱, en hý wou die asmapompie se oranje doppie “SELF” (julle ken mos daai woord😉🙈) afgehaal het. Emosies het behoorlik gesneeubal in ‘n sneeu(senu-ineen)storting…

Vanaand is almal moeg. Hierdie mamma het nog soveel om te doen voor dit mý beurt is om in te kruip. En hier sit Oudste Kabouter steeds kiertsregop en verseg om te slaap. “Want Mamma moet by my lê!” (Alhoewel Pappa nog altyd die laaste paar maande goed genoeg was!)…

Ek bid vir wysheid. Ek bid vir onderskeiding: Dat ek sal weet wat om te doen, wat om te sê.
Wanneer is dit als net die moegheid wat praat en wanneer is dit pure ongehoorsaamheid (soos wanneer hy aspris kliphard geluide maak as ek met manlief probeer praat)?

Wanneer moet ek grense stel en dissiplineer en wanneer het hy net liefde en aanvaarding nodig – net vir my nodig om by hom te wéés?

Vanaand het ek die “by-hom-te-wees” opsie gekies, my arms om sy snikkende lyfie gevou en hom net vasgehou. ‘n Paar sout-trane-soentjies op die wang en twee snot-tissues later, krul sy mondhoekies weer in ‘n half-glimlag op en soek sy groot oë myne. En ek weet in my hart dit was die regte besluit. Ons siele het ontmoet en ons verhouding het verdiep.

MAGTELOOS

Voel ander mammas ook so magteloos?
Ek wil jou net só graag troos…
Ek voel ek het al ALS probeer
Maar hoekom klink jy steeds hartseer?
Jou skrille-skreeu sny tot binne my
Niks sou my óóit kon voorberei
Soms voel ek vreeslik swak en dom
Hierdie is my beste poging
Al is dit skeef en krom
Weet net mamma is SO lief vir jou
En wil jou altyd naby hou.


Ek wens ek het geweet hoe om jou te troos…ek wens jy kon my sê…dit lyk of jy in pyn is….dalk ‘n wind wat vassit? Dalk krampe? Dalk oorpyn? Miskien kry jy tande? (Dis dalk nog ‘n bietjie te vroeg daarvoor…) Kry jy koud? Kry jy te warm? Jou doek is droog. Ek’t dit sopas geruil. Is jy nog honger?…

Klink dit vir jou bekend?
Voel jy ook so? Het jy ook al herhaaldelik deur dié soort lysie in jou kop gegaan?

Vrede vir jou, mede-mamma.

KLEUTER-REDENASIES

Mamma-wees beteken elle-lange kreatiewe redenasies met jou ‘mini-me’.

Medicine Mommy SA

Ons is alweer op die antibiotika-trein…Oudste het middeloorontsteking. Eina.
Maar “high5” vir hom, want hy is ‘n regte kampioen – glimlag steeds en kla basies niks.

Die probleem kom egter in as dit medisyne-tyd raak…Die melkerige mengsel met die meelerige tekstuur en bitter na-smaak laat niemand se mond water nie! Nog minder ‘n amper 3-jarige s’n. Liewe genade, kon die stropie nie maar sjokolade- of selfs bessiegeur gewees het nie? – so aanloklik soos die Vitamien-beertjies of Reuterina koutablette! Dáái eet hy met graagte. Hy vra sommer vir nog!

Vandag was dit weer ‘n omkopery met appelsap (die bitter medisyne het in ‘n Paw Patrol glasie saam met die soet sap opgeëindig) – dít wou hy steeds nie drink nie. “Néé, mamma, hoekom? Hoekom moet ek dit drink?!” (Ja, ons is op die “hoekom” stadium…volgende storie dalk?) Natuurlik verduidelik ek…maar my antwoorde beïndruk Meneer maar min.

Toe word hy ge”bribe” met ‘n einste Vitamien-beertjie…maar toe die een beertjie nie die “trick” doen nie, maak ek toe maar die omkoopprys meer aanloklik en bied noodgedwonge 2 aan. Hierdie taktiek het gewerk, en ons kon aanbeweeg na die Calpol-stroop. Gewoonlik word só koppie sonder te veel bohaai afgesluk, maar vandag moes hierdie mamma maar ‘n Paw Patrol episode inruil vir die Calpol-drankie aanbied.

Mammas, sê my julle kan ‘relate’ ? 🙈🙃

(Diep asemhaal, tel tot…20… en nogsteeds) Vrede 😉,
Alyssa ♡