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Common Causes of Anemia in ChildrenThe most common form of anemia in children is iron-deficiency anemia. This is because:
(1) Insufficient iron stores at birth. Normal full-term newborns receive enough iron from the mother to meet their hematopoietic needs for the first 3–4 months after birth. However, premature birth, twin birth, fetal blood loss, or maternal iron-deficiency anemia can all lead to insufficient iron stores in infants.
(2) Insufficient iron intake. The diet of newborns primarily consists of breast milk or cow's milk, both of which have low iron content. If infants are fed only milk without timely supplementation of iron-rich foods, they are prone to anemia.
(3) Rapid growth and development. Infancy is a period of rapid growth. By 3–5 months, an infant's weight is double that at birth, and by 1 year, it is three times the birth weight. Premature infants gain weight even faster. As body weight increases, blood volume also rises rapidly, making it easier to develop iron deficiency and anemia.
(4) Excessive iron loss. Normal infants excrete more iron daily than adults, and iron loss through the skin is also relatively high. If protein allergies lead to intestinal bleeding, iron loss is even greater. Additionally, diseases such as chronic diarrhea, intussusception, intestinal polyps, and others can increase iron consumption and cause anemia.
### What Is Iron-Deficiency Anemia?
Iron-deficiency anemia (IDA) is a microcytic, hypochromic anemia caused by insufficient stored iron, which impairs hemoglobin synthesis. It is the most common type of anemia worldwide, including in China. The incidence rate is very high, affecting nearly all regions globally, with children, adults, and the elderly all at risk. In areas where hookworm disease is prevalent, the rate is particularly high. According to World Health Organization (WHO) surveys, approximately 10%–30% of the global population has varying degrees of iron deficiency. The prevalence is about 10% in males and over 20% in females. Asia has a higher incidence rate than Europe. WHO reports indicate that in developing countries, half of women suffer from anemia due to malnutrition, termed "nutritional anemia." The incidence in women, especially pregnant women, may be up to 10 times higher than in men. Outside of China, among 464 million women of childbearing age (15–19 years) in developing countries, about 230 million are affected. India may become the country with the highest number of anemia cases globally, with pregnant women accounting for 60%–80% of cases. The primary causes of malnutrition are first iron deficiency, followed by a lack of vitamin B12. Given the widespread incidence and the high number of affected women, this is a shocking and significant issue, warranting global attention. Preventing nutritional anemia has become a worldwide concern.
### Rational Use of Iron Supplements
Iron supplements are effective in treating iron-deficiency anemia, but improper use can reduce efficacy and delay treatment. Therefore, when using iron supplements, the following points must be noted:
First, select appropriate iron supplements based on the severity of the condition:
1. For mild anemia, ferrous sulfate is recommended. However, if the patient has gastrointestinal diseases or is a severely reactive pregnant woman, ferrous sulfate should be avoided in favor of iron dextran, as it is less irritating to the gastrointestinal tract.
2. For severe anemia, iron dextran can quickly alleviate the deficiency of iron needed for hematopoiesis and prevent complications such as heart disease.
3. For infants and young children with anemia, ferrous ammonium citrate syrup is preferred.
Second, take the medication at the right time:
Iron is primarily absorbed in the duodenum. Since food slows gastrointestinal motility and prolongs the retention of iron supplements in the duodenum, taking them 30 minutes after a meal is ideal. This not only increases iron absorption but also significantly reduces gastrointestinal irritation. Thirty minutes after a meal, when gastric acid secretion is high, iron absorption is more efficient. Recent chronopharmacokinetic studies have found that taking iron at 7 PM doubles its absorption compared to 7 AM, making 7 PM the best daily time for iron supplementation.
Third, precautions:
1. During iron supplementation, consume more fructose, fruits, fruit juices, and acidic foods to promote iron absorption.
2. Simultaneously taking vitamin C and dilute hydrochloric acid, at standard doses, can aid iron absorption.
3. Avoid taking rutin, tetracyclines, neomycin, allopurinol, chloramphenicol, iopanoic acid, cholestyramine, cimetidine, penicillamine, vitamin E, hydralazine, aspirin, compound Salvia miltiorrhiza tablets, pancreatic enzyme preparations, oral contraceptives, calcium carbonate, magnesium oxide, aluminum hydroxide, nitrofurantoin, proglumide, and calcium/magnesium-containing antacid herbal medicines.
4. Avoid drinking tea, as tannins in tea can bind with iron and hinder its absorption.
5. Consult a doctor before supplementing iron in children.
6. Iron supplements can combine with hydrogen sulfide in the intestines to form black iron sulfide, causing dark stools. Inform patients in advance to prevent unnecessary anxiety.
Fourth, treatment duration:
After starting iron supplements, normal levels can usually be restored within 1–2 months. However, it is crucial to continue taking the medication for at least another month after normal levels are achieved, followed by a 2–3-month maintenance period, to fully restore iron stores in the body. Otherwise, if supplementation is stopped, anemia may return, and treatment will have to start over.
### Parents Giving Their Children "Iron-Rich Vegetables"
Today, iron-deficiency anemia in children has become another "affluent child disease" alongside obesity and myopia. Doctors point out that an unbalanced diet, picky eating, and poor eating habits are major causes of anemia in children.
Doctors say that, apart from a few cases of congenital physical influences, the main reasons for anemia in children are related to their daily diet and lifestyle. Many children drink yogurt or eat chocolate as soon as they wake up, some drink frozen milk or eat fruit on an empty stomach in the morning, and some parents who skip breakfast also cause their children to do the same. Children who go to bed late and wake up early with their parents often don't have time for a proper breakfast, and over time, they may develop anemia.
If adolescents with iron-deficiency anemia do not receive timely iron supplementation, they may experience symptoms such as reduced physical strength, memory decline, and decreased cellular immunity, making them more susceptible to colds and tracheitis.