ANEMIA

Definition: A condition of reduced red blood cells in the circulatory system.

Note: This is always a worrisome condition in childhood. Anemia can make children sluggish and decrease their capacity to perform. There is no reason why the cause of anemia cannot be fully established and appropriate treatment rendered if necessary.

1. What causes this condition to occur in my child?

Anemia occurs when there are not enough red blood cells to meet the needs of the child. Red blood cells carry oxygen to the various parts of the body. There are three reasons why a child may become anemic.

The first cause is bleeding. If the child is losing red blood cells from the body, whether it is from chronic nosebleeds or from bleeding in the gastrointestinal tract, eventually the red blood cell count will go down, and the child could become anemic.

     The second reason why a child may become anemic is if the body is unable to produce sufficient amounts of red blood cells. The most common reason in childhood is a lack of sufficient iron in the diet. This occurs most frequently in children between the ages of one and two who have had a diet made up primarily of cow’s whole milk. If the child is not getting sufficient iron in the diet, then the child is not able to make sufficient red blood cells. This can result in severe anemia. 

     The third reason why a child may become anemic would be if the red blood cells that the child produced do not survive in the body for a normal period of time. Normally, once red blood cells are made, the red blood cells will last in the body for approximately three months. There are a number of conditions that could cause the red blood cells to break down earlier than normal. In general, these are called hemolytic anemias. There are many different types of hemolytic anemia. Some types are inherited and are not correctable. Some types occur after certain viral illnesses and will eventually get better.

2. What tests are needed to better define the condition?

The first step is to measure the amount of hemoglobin and red cells in the body. Then, the physician or the laboratory technician will look at the red blood cells under the microscope. This will often give the physician a clue as to what is causing the anemia.

     The physician then might order a number of different tests to deter- mine the diagnosis. For instance, if the physician feels that the child may be losing blood, the physician may order special tests on the stool to look for any signs of blood. The physician also might want to measure the amount of iron in your child’s body. There are many tests that can better define the reasons for anemia.

3. How is it treated, and is it correctable?

The treatment for anemia depends on its cause. If the anemia is due to bleeding, then the cause for the bleeding must be determined, and corrective action will be taken. If the anemia is due to an insufficient amount of iron in the diet, then the patient will be placed on supple- mental iron, and often a change in diet is warranted. Some types of anemia are not correctable, though the most common forms of anemia are easily correctable.

4. Are there any potential side effects of the treatment?

There is always the possibility of side effects with any treatment, but in general, the treatment of anemia is well tolerated. Certain oral iron preparations may cause some temporary discoloration of the teeth or some belly pains or some constipation. Often, the physician can change the type of iron supplementation to meet your child’s needs.

5. What symptoms will my child have as a result of the condition?

In general, the symptoms of anemia are not seen in childhood until the anemia is fairly severe. The signs of anemia generally include fatigue and lack of energy.

6. Do we need to consult a hematologist (blood disorder specialist)?

Most pediatricians are able to diagnose and treat the more common causes of anemia in childhood. Sometimes the pediatrician will request a consultation from a pediatric hematologist for advice in treating anemia.

7. How often will my child need to be tested in the future to see if the condition is improving?

This depends on the cause of the anemia. If the anemia is due to iron deficiency, then the child will be tested several times in the first year or two to make sure that the condition is improving. In other cases of anemia, the scheduling for repeat testing will depend on the cause of the anemia.

8. When do you wish to see my child again regarding this disorder?

The frequency of visits to the doctor for the treatment of anemia will depend upon the cause of the anemia. In general, several trips to the doctor will be required in the first six months to a year if the anemia is due to iron deficiency. 

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Pica

Many young kids put nonfood items in their mouths at one time or another. They're naturally curious about their environment and might, for instance, eat some dirt out of the sandbox.

Kids with pica, however, go beyond this innocent exploration of their surroundings. Between 10% and 30% of kids ages of 1 to 6 years have the eating disorder pica, which is characterized by persistent and compulsive cravings (lasting 1 month or longer) to eat nonfood items.

 

 

About Pica

The word pica comes from the Latin word for magpie, a bird known for its large and indiscriminate appetite.

Pica is most common in people with developmental disabilities, including autism and mental retardation, and in children between the ages of 2 and 3. Pica also may surface in children who've had a brain injury affecting their development. It can also be a problem for some pregnant women, as well as people with epilepsy.

People with pica frequently crave and consume nonfood items such as:

• dirt
• clay
• paint chips
• plaster
• chalk
• cornstarch
• laundry starch
• baking soda
• coffee grounds
• cigarette ashes
• burnt match heads
• cigarette butts
• feces
• ice
• glue
• hair
• buttons
• paper
• sand
• toothpaste
• soap

Although consumption of some items may be harmless, pica is considered to be a serious eating disorder that can sometimes result in serious health problems such as lead poisoning and iron-deficiency anemia.

Signs of Pica

Warning signs that a child may have pica include:

• repetitive consumption of nonfood items, despite efforts to restrict it, for a period of at least 1 month or longer
• the behavior is considered inappropriate for your child's age or developmental stage (older than 18 to 24 months)
• the behavior is not part of a cultural, ethnic, or religious practice

Why Do Some People Eat Nonfood Items?

The specific causes of pica are unknown, but certain conditions and situations can increase a person's risk:

• nutritional deficiencies, such as iron or zinc, that may trigger specific cravings (however, the nonfood items craved usually don't supply the minerals lacking in the person's body)
• dieting — people who diet may attempt to ease hunger by eating nonfood substances to get a feeling of fullness
• malnutrition, especially in underdeveloped countries, where people with pica most commonly eat soil or clay
• cultural factors — in families, religions, or groups in which eating nonfood substances is a learned practice
• parental neglect, lack of supervision, or food deprivation — often seen in children living in poverty
• developmental problems, such as mental retardation, autism, other developmental disabilities, or brain abnormalities
• mental health conditions, such as obsessive-compulsive disorder (OCD) and schizophrenia
• pregnancy, but it's been suggested that pica during pregnancy occurs more frequently in women who exhibited similar practices during their childhood or before pregnancy or who have a history of pica in their family

Eating earth substances such as clay or dirt is a form of pica known as geophagia, which can cause iron deficiency. One theory to explain pica is that in some cultures, eating clay or dirt may help relieve nausea (and therefore, morning sickness), control diarrhea, increase salivation, remove toxins, and alter odor or taste perception.

Some people claim to enjoy the taste and texture of dirt or clay, and eat it as part of a daily habit (much like smoking is a daily routine for others). And some psychological theories explain pica as a behavioral response to stress or an indication that the individual has an oral fixation (is comforted by having things in his or her mouth).

Another explanation is that pica is a cultural feature of certain religious rituals, folk medicine, and magical beliefs. For example, some people in various cultures believe that eating dirt will help them incorporate magical spirits into their bodies.

None of these theories, though, explains every form of pica. A doctor must treat each case individually to try to understand what's causing the condition.

When to Call the Doctor

If your child is at risk for pica, talk to your doctor. If your child has consumed a harmful substance, seek medical care immediately. If you think your child has ingested something poisonous, call Poison Control at (800) 222-1222.

A child who continues to consume nonfood items may be at risk for serious health problems, including:

• lead poisoning (from eating paint chips in older buildings with lead-based paint)
• bowel problems (from consuming indigestible substances like hair, cloth, etc.)
• intestinal obstruction or perforation (from eating objects that could get lodged in the intestines)
• dental injury (from eating hard substances that could harm the teeth)
• parasitic infections (from eating dirt or feces)

Medical emergencies and death can occur if the craved substance is toxic or contaminated with lead or mercury, or if the item forms an indigestible mass blocking the intestines. Pica involving lead-containing substances during pregnancy may be associated with an increase in both maternal and fetal lead levels.

What Will the Doctor Do?

Your doctor will play an important role in helping you manage and prevent pica-related behaviors, educating you on teaching your child about acceptable and unacceptable food substances. The doctor will also work with you on ways to to restrict the nonfood items your child craves (i.e., using child-safety locks and high shelving, and keeping household chemicals and medications out of reach).

Some kids require behavioral intervention and families may need to work with a psychologist or other mental health professional.

Depending on a child's age and developmental stage, doctors will work with kids to teach them ways to eat more appropriately. Medication may also be prescribed if pica is associated with significant behavioral problems not responding to behavioral treatments.

Your doctor may check for anemia or other nutritional deficiencies, if indicated. A child who has ingested a potentially harmful substance, such as lead, will be screened for lead and other toxic substances and might undergo stool testing for parasites. In some cases, X-rays or other imaging may be helpful to identify what was eaten or to look for bowel problems, such as an obstruction.

Fortunately, pica is usually a temporary condition that improves as kids get older or following pregnancy. But for individuals with developmental or mental health issues, pica can be a more prolonged concern.
Following treatment, if your child's pica behavior continues beyond several weeks despite attempts to intervene, contact your doctor again for additional treatment. Remember that patience is key in treating pica because it can take time for some kids to stop wanting to eat nonfood items.

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Anemia

Anemia

Iron is a necessary nutrient for a healthy body, especially when you are pregnant; yet 20 percent of pregnant women don't get enough iron, which can lead to a low red blood cell count, or anemia. Before you became pregnant, you needed 15 milligrams of iron a day; but now your daily requirement has doubled to 30.

During your pregnancy, you have twice as much blood flowing through your body to support your growing baby, and you need extra iron to make more hemoglobin for all that new blood. Hemoglobin is the protein in your blood that carries precious oxygen to your body's tissues and growing baby.

If you become anemic during pregnancy, you may become excessively fatigued; have a tendency to get stressed and sick; or develop a pale complexion, shortness of breath, fast or irregular heartbeats, weakness, dizziness, light-headedness, or fainting spells. If your anemia is very severe, your baby's growth may slow and you may be at risk for premature delivery. And if you are anemic when you deliver, it may be difficult for you to recover from the loss of blood, an infection, or other possible complications of delivery.

You may also become anemic if you have a folic acid or vitamin B deficiency, lose a lot of blood from an injury or surgical procedure, or if you have a chronic illness such as kidney disease.

Your caregiver probably tested you for anemia at your first prenatal appointment and will continue to test you at every appointment thereafter. He or she will probably recommend you take a prenatal vitamin that contains iron as a preventative measure against anemia, and if you develop anemia sometime during your pregnancy, it will probably be treated with an iron supplement. Taking an iron supplement may make your morning sickness worse and can cause constipation, so try to drink more fluids and take the supplement at night before going to bed to minimize your discomfort. Do not take an iron supplement with milk as it can prevent the absorption of iron.

To prevent anemia, eat foods that are high in iron, such as red meat, dried beans, leafy green vegetables, dried fruits, and fortified breads, pastas, and cereals. In addition, be sure to get plenty of vitamin C (which aids iron absorption), vitamin B, and folic acid.

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