Anemia in Children

Anemia is a common problem in children. About 20% of children in the U.S. will be diagnosed with anemia at some point. A child who has anemia does not have enough red blood cells or hemoglobin. Hemoglobin is a type of protein that allows red blood cells to carry oxygen to other cells in the body.

There are many types of anemia. Your child may have one of the following:

• Iron deficiency anemia. Too little iron in the blood. Iron is needed to form hemoglobin. This is the most common cause of anemia. 
• Megaloblastic anemia. Red blood cells are too large. One type of megaloblastic anemia is pernicious anemia. In this type, there is a problem absorbing vitamin B₁₂, important to making red blood cells.
• Hemolytic anemia. Red blood cells are destroyed. There are many different causes, such as serious infections or certain medications.
• Sickle cell anemia. An inherited type of anemia with abnormally shaped red blood cells. It is a type of hemolytic anemia.
• Cooley's anemia (thalassemia). Another inherited type of anemia with abnormal red blood cells.
• Aplastic anemia. Failure of the bone marrow to make blood cells.

Anemia has 3 main causes:

• Loss of red blood cells
• Inability to make enough red blood cells
• Destruction of red blood cells

Decreased red blood cells or hemoglobin levels may be due to:

• Inherited red blood cell defects
• Infections
• Some diseases
• Certain medicines
• Lack of some vitamins or minerals in the diet

Risk factors for anemia include:

• Premature or low birth weight
• Living in poverty or immigrating from developing country
• Early use of cow’s milk
• Diet low in iron, or some vitamins or minerals
• Surgery or accident with blood loss
• Long-term illnesses, such as infections, or kidney or liver disease
• Family history of an inherited type of anemia, such as sickle cell anemia

Most symptoms of anemia are due to the lack of oxygen in the cells. Many of the symptoms are not present with mild anemia.

These are the most common symptoms:

• Increased heart rate
• Breathlessness, or trouble catching a breath
• Lack of energy, or tiring easily
• Dizziness, or vertigo, especially when standing
• Headache
• Irritability
• Irregular menstrual cycles
• Absent or delayed menstruation
• Sore or swollen tongue
• Jaundice, or yellowing of skin, eyes, and mouth
• Enlarged spleen or liver
• Slow or delayed growth and development
• Poor wound and tissue healing

The symptoms of anemia may look like other blood problems or health conditions.  Anemia is often a symptom of another disease. Be sure to report any symptoms to your child’s doctor. Always see your child's doctor for a diagnosis.

Because anemia is common in children, doctors do routine screening for it. Plus, it often has no symptoms. Most anemia in children is diagnosed with these blood tests:

• Hemoglobin and hematocrit. This is often the first screening test for anemia in children. It measures the amount of hemoglobin and red blood cells in the blood.
• Complete blood count, or CBC. A complete blood count checks the red and white blood cells, blood clotting cells (platelets), and sometimes, young red blood cells (reticulocytes). It includes hemoglobin and hematocrit and more details about the red blood cells.
• Peripheral smear. A small sample of blood is examined under a microscope to see if they look normal.

To get a blood sample, a healthcare provider will insert a needle into a vein, usually in the child's arm or hand. A tourniquet may be wrapped around the child's arm to help the healthcare provider find a vein. Blood is drawn up into a syringe or a test tube. In some cases, blood can be taken using a needle prick.

Blood tests may cause a little discomfort while the needle is inserted. It may cause some bruising or swelling. After the blood is removed, the healthcare provider will remove the tourniquet, put pressure on the area, and put on a bandage.

Depending on the results of the blood tests, your child may also have a:

• Bone marrow aspiration, biopsy, or both. This involves taking a small amount of bone marrow fluid (aspiration) or solid bone marrow tissue (called a core biopsy). The fluid or tissue is examined for the number, size, and maturity of blood cells and/or abnormal cells. 

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

The treatment for anemia depends on the cause. Some types do not require treatment. Some types may require medicine, blood transfusions, surgery, or stem cell transplants. Your child's healthcare provider may refer you to a hematologist. This is a specialist in treating blood disorders. Treatment may include:

• Vitamin and mineral drops or pills
• Changing your child's diet
• Stopping a medicine that causes anemia
• Medicine
• Surgery to remove the spleen
• Blood transfusions
• Stem cell transplants

The complications of anemia depend on what is causing it. Some types have few complications, but others have frequent and serious complications. Some anemias may cause:

• Problems with growth and development
• Joint pain and swelling
• Bone marrow failure
• Leukemias or other cancers

Some types of anemia are inherited and can’t be prevented. Iron deficiency anemia, a common form of anemia, may be prevented by making sure your child gets enough iron in his/her diet. This is done by the following:

• When your baby is breast fed he or she will get enough iron from the breast milk.
• Cow’s milk does not provide enough iron. It should not be given to babies until after 1 year of age, when he or she is eating enough other food. 
• If your child is on formula, use formula with added iron.
• Choose foods that are good sources of iron including: iron-enriched grains and cereals, egg yolks, red meats, potatoes, tomatoes, and raisins. 

Call your child's healthcare provider if you notice that your child has any of the symptoms of anemia. And, if your child has not been checked for anemia, talk with the provider about your child's risk of getting it.

• Anemia is a low red blood cell count or a low hemoglobin level.
• There are many different causes of anemia. 
• Children are usually screened for anemia. Often there are no symptoms.
• The treatment of anemia depends on what is causing it.

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.