The American Academy of Pediatrics, the World Health
Organization and other well-known pediatric organizations
have proposed many recommendations
for the prevention of iron deficiency anemia
which is the most common
nutritional deficiency in the world.
These recommendations include
enrichmeent of foods with iron,
giving iron-rich formulas when breast milk is insufficient,
avoiding cow's milk in the first year of life,
giving infants iron prophylaxis and screening infants
in the first 9 to 12 months of life for this anaemia
to see if supplementation is indicated,
and preventing premature delivery because remember these
infants are building up their stores from their mother in-utero
and when they're born too soon,
their stores are not adequate.
The main principles in the treatment of iron
deficiency anemia include making the diagnosis,
investigating and eliminating the condition.
so how do we replace the iron?
Well we can do this in a few ways.
The first through foods.
Non-heme iron is found in plant based
foods such as nuts, fruits and vegetable.
Foods with non-heme iron are still an
important part of a nutritious well-balanced diet
but the iron containing these foods
will not be absorbed completely.
You only absorb between 2 and 10%
of the non-heme iron that you consume.
Another option is heme iron and that's found in
meats and meat products and the absorption is higher.
You can also replace iron orally
and this is through ferrous sulfate.
It has high bioavailability.
The problem is it can cause GI upset, it can
also cause constipation, nausea and vomiting.
And I always tell my patients that if they get a really
upset stomach when they're taking their iron supplement,
sometimes they just stop taking it and we can come
up with other options to augment their iron intake.
In addition, it can cause black discoloration of the
stool so I am always careful to warn my patients of this.
You want to take this one hour
before or 2 hours after meals
and this is a problem because it's better tolerated if
you take it with food but it decreases the absorption.
And you always want to remind patients that
vitamin C is going to increase their absorption
so maybe they take it with
a little bit of orange juice.
Parenteral options are also there,
you can do intramuscular or IV infusions
and these are usually in settings of malabsorption like celiac
or inflammatory bowel disease where orals are not an option.
What are complications?
Well patients can have impaired physical
growth and compromise cognitive development.
Some patients will also develop
impaired learning capacity.
There is reduced muscle function because
of the decreased oxygen to the tissues.
There's also decreased physical
activity and a lower work productivity.
The patient's gonna have a lower immunity
and an increased risk for infectious disease.