Causes, symptoms, diagnosis and treatment
Children can often seem tired or irritable, but when these symptoms become a permanent problem, it could be a sign of something more serious.
Fatigue, pale skin and even bad moods can be signs of anemia, especially in babies born preterm, with low birth weight or whose cords were pinched immediately after birth.
Anemia is the most common nutritional deficiency in the world, and anemia caused by iron deficiency and other problems can be cause for concern not only for the symptoms they cause, but also for the long-term effects on development that may result.
This article will help you understand what anemia is and the different forms of this condition, as well as what to expect if your child develops anemia.
Anemia occurs when the number of red blood cells in a person’s blood is lower than normal or when the amount of hemoglobin in the red blood cells is too low.
Hemoglobin is a protein in your red blood cells that carries oxygen throughout your body and removes carbon dioxide. A low hemoglobin level can mean that there is too little oxygen or too much carbon dioxide in your body.
Anemia can develop in several ways. Below are some of the different types of anemia and an explanation of how each causes symptoms.
Iron is a mineral your body needs to make hemoglobin. Low iron levels – often due to insufficient dietary intake – can decrease the amount and effectiveness of hemoglobin in your body.
Iron deficiency anemia is the most common type of anemia. Despite the frequency of this condition, many people are unaware that they have iron deficiency anemia and attribute their symptoms to other causes.
These types of anemias are defined by the size of your red blood cells. In people with microcytic anemia, the red blood cells are smaller and paler than they should be. This indicates a decrease in their ability to transport oxygen.
Although iron deficiency is one of the main causes of this type of anemia, other causes can include:
Determining the underlying cause of the specific type of microcytic anemia a person has is key to effective treatment.
Macrocytic anemias result from too large red blood cells. These larger red blood cells are not mature, so they don’t do the same job as normal red blood cells.
Macrocytic anemias are divided into two categories:
- Megaloblastic anemia: This happens when the problem is caused by a DNA error in the way your blood cells are produced.
- Non-megaloblastic anemia: It happens when the cause is other factors like medications or lifestyle choices.
Megaloblastic anemias are often caused by things like:
Non-megaloblastic forms are caused by things like:
- chronic alcohol consumption
- liver disease
Hemolytic anemia is a type of anemia in which your red blood cells are normal in size, shape, and function, but their lifespan is shortened.
Each type of cell has a normal lifespan, but in hemolytic anemia something causes your red blood cells to die quickly or prematurely – and faster than they can be replaced.
Extrinsic hemolytic anemia is the name given to anemias in this category that are caused by some kind of malfunction that destroys your red blood cells. Examples include things like:
Hemolytic anemias can also have an intrinsic cause, which develops because your red blood cells aren’t working as they should. Examples include sickle cell anemia and thalassemia.
sickle cell anemia
Sickle cell anemia is a type of intrinsic hemolytic anemia. With this form of anemia, the red blood cells are C-shaped and become sticky and stiff. This abnormal shape makes these cells prone to getting stuck in blood vessels, causing pain, tissue damage, and even blood clots.
Not all red blood cells are affected by the sickle shape, but it is usually enough to produce noticeable symptoms of anemia. There are several forms of sickle cell anemia, but all are inherited genetic conditions that usually appear within the first few months of a child’s life.
Thalassemia is the name given to a group of blood disorders that affect the proteins that make up hemoglobin.
Hemoglobin is made up of two types of protein – alpha and beta – and the type of thalassemia you have is determined by whether you are deficient in alpha or beta protein.
A beta protein deficiency creates the most severe type of thalassemia, often called thalassemia major or Cooley’s anemia. This form of the disease, due to a complete lack of beta protein, creates a life-threatening shortage of hemoglobin function that requires lifelong, regular blood transfusions.
Cooley’s anemia usually appears before the age of 2 and over time can lead to complications due to iron buildup from numerous blood transfusions.
Aplastic anemia is a type of anemia where, for one reason or another, your bone marrow simply does not produce enough red blood cells.
There are many things that can damage the bone marrow, and often the cause of this type of anemia has multiple contributors or is completely unknown.
Some possible contributors to aplastic anemia include:
- autoimmune disease
- some viruses like Epstein-Barr and HIV
Symptoms of anemia in children are similar to those in adults. But, depending on their age, they might have a hard time telling you how they feel.
Some of the more common symptoms seen in children with iron deficiency anemia include:
Other forms of anemia can have a variety of symptoms, but the condition can also develop without any symptoms. In some cases, anemia can be diagnosed by blood tests done for other purposes.
The cause of anemia depends on the type, but for many children the condition is the result of an inherited or genetic condition that affects the way red blood cells form or work.
Iron deficiency anemia in infants and young children is usually diet-related, due to a delay in the introduction of iron-fortified foods or iron supplements. Food allergies and other feeding difficulties can also contribute to the disease.
The main causes of microcytic anemias in children can also include:
- iron deficiency
Normocytic anemias in children are often caused by factors such as:
- blood loss
- autoimmune attacks on red blood cells
- iron deficiency
- sickle cell disease
- hemolytic diseases
- bone marrow disorders
- other red blood cell disorders
Macrocytic anemias in children are usually caused by problems such as:
- congenital aplasia
- vitamin B12 deficiency
- folate deficiency
Diagnosing anemia in young children can be difficult, as symptoms can be mild or shared with a number of other conditions.
Your doctor will begin working on a diagnosis by asking you questions about individual and family medical histories, other conditions, medications, diet, and development.
A complete blood count (CBC) is a test performed on a blood sample taken in a laboratory, and it is the most common diagnostic test for anemia. This test will give a count of all types of blood cells in a sample.
Anemia can be diagnosed by comparing your child’s red blood cell count and hemoglobin level to normal values.
The treatment of anemia in children will depend on:
- the severity of your child’s anemia
- the type of anemia
- any underlying conditions contributing to the problem
Iron deficiency anemia is the most common type of anemia in children and is usually treated with iron supplementation and dietary changes. If iron supplements are needed, your doctor will recommend a specific formulation and dosage based on your child’s age and level of iron deficiency.
In less severe cases, or alongside supplementation, your doctor may also suggest increasing the amount of iron-fortified or iron-rich foods in your child’s diet. This can include foods like:
- Red meat
- iron-fortified cereal
- beans and lentils
- dark green leafy vegetables
Along with adding iron-rich foods to your child’s diet, it’s also helpful to increase iron absorption in the body by combining them with vitamin C-rich foods like:
- citrus fruits
- Sweet potatoes
- dark green leafy vegetables
With severe anemia or certain types, such as Cooley’s anemia, your child may need blood transfusions or other ongoing treatments.
There are several forms of anemia that are inherited or run in families, so a family or parental history of anemia may indicate some level of risk.
Beyond that, a number of factors can increase the risk of developing anemia. These include:
Symptoms of anemia in children may go unnoticed or even be attributed to normal growth cycles. Be sure to discuss your child’s diet and the recommended amounts of iron your child needs during routine well visits.
If you see signs of severe bleeding, fatigue, or lethargy, see or call your pediatrician or healthcare professional.
Iron deficiency anemia is the most common form of this condition in young children and is usually treated with diet and supplements.
In most cases, anemia is a short-term, treatable condition. In some cases, however, children with certain other forms of anemia may require ongoing medical treatment to maintain their blood counts and prevent complications such as organ failure.
Anemia in children can manifest as fatigue, paleness, irritability, or even cognitive problems.
In most cases, anemia in children can be attributed to iron deficiency. Diet changes and supplementation can help. More severe cases – especially with specific genetic causes of anemia – may require ongoing care and treatment, which includes regular blood transfusions.
If you think your child has iron deficiency or anemia, talk to your pediatrician. They can do blood tests and provide treatment advice.