nutritional anemia in children

Nutritional anemia in children is a common nutritional problem in children aged 6 months to 14 years old. More than 90% of them are iron deficiency anemia. Early detection and early intervention can completely reverse it without leaving any health damage. However, if no intervention is performed for a long time, it will directly affect cognitive development, immunity level and growth rate.

The 3-year-old girl Bao Duoduo was picked up from the outpatient clinic last Wednesday. Her hemoglobin was only 92g/L during the physical examination upon admission. Her mother clutched the report and was confused. She said that except for not eating pork and beef, she squatted down to rest after running two steps. Everything else was normal. Why was she anemic? In fact, this situation is too common. In the past six months, the children who were diagnosed with anemia during the physical examination after entering kindergarten were nine out of ten who did not like to eat red meat.

Many people's first reaction is to blame the anemia entirely on their children's picky eaters. In fact, this is not entirely true. Exclusively breastfed babies under 6 months old are prone to anemia early if the mother has anemia problem and the iron reserves brought by the baby from the mother are insufficient. ； For babies who have just started to receive complementary feeding, parents are always worried that their children will not digest well, so they only feed them fine rice cereal, and fail to keep up with red meat puree and liver puree in time. The iron intake cannot keep up with consumption, and the index will drop within two months. ； Older children either have high-sugar snacks that occupy their stomach capacity and cannot eat serious meals, or their family’s diet is relatively vegetarian and they rarely eat animal foods. ； There are also adolescent girls who lose a lot of iron every month after menarche and secretly go on a diet in order to lose weight. They are also at high risk of nutritional anemia.

Regarding how to intervene, the pediatric nutrition circle has actually always had two different practical ideas. There is no absolute right or wrong, only the suitability. One is to insist on giving priority to food supplements, believing that as long as the diet structure is adjusted, mild anemia (hemoglobin under 6 years old 100-110g/L) can be brought back without supplements. Many friends around me who provide family nutrition guidance hold this view. There used to be a 4-year-old boy with a hemoglobin of 103. His mother gave him 50g of lean beef every day, 15g of chicken liver twice a week, and half a cherry tomato after the meal to supplement vitamin C. In less than two months, the hemoglobin rose to 118, and even the doctor who wrote the order was surprised. Another view is more common in clinical practice: as long as the hemoglobin is lower than the normal value, a two-pronged approach of supplements + food supplements is recommended. After all, there are too few children who can cooperate well with eating red meat and liver. Food supplements are inefficient and will affect their development for a long time. This is especially true for children who have symptoms of pale complexion, fatigue easily, and poor concentration. It will take at least 3 months to catch up with food supplements, which is far less effective than standard supplements.

To be honest, every time I meet a parent who feeds his children five red soup and red dates and brown sugar to supplement iron, I have to persuade them for a long time, but it’s really useless. The iron in 100g of dried red dates is only 2mg, which is still non-heme iron, and the absorption rate is less than 3%. The iron in 100g of pork liver is 22.6mg, and the absorption rate can be more than 20%, which is dozens of times different. Drinking red soup five times a week is really not as good as eating a bite of pork liver. On the contrary, eating too much brown sugar and red dates can easily lead to tooth decay, which is not worth the gain. Some parents buy iron supplements because they are afraid of irritating the stomach and feed them on an empty stomach, or give their children milk immediately after drinking, which is basically a white supplement - ferrous iron needs to be absorbed in an acidic environment. It is best to take it half an hour after a meal, with some fruits with high vitamin C such as oranges and kiwis, which can double the absorption efficiency. Also, avoid taking it with calcium and tea, otherwise it will inhibit iron absorption.

In the five years I have been doing pediatric nutrition consulting, I have encountered no less than 200 cases of children with nutritional anemia. The most regrettable thing is that the parents do not take it seriously. They always think that "it is normal for children to be pale" and "it will be fine when they are older." When the children are in elementary school, they can't concentrate and sit in the front row of the classroom every year. In fact, it is really not difficult to prevent and control this problem: when adding complementary foods at 6 months old, arrange red meat puree in time. Don’t always think that the child can’t bite and just don’t give it. ； Pay more attention to the hemoglobin value during the annual physical examination and blood routine. A project worth more than ten yuan is more effective than anything else. Don’t panic if you are really diagnosed with anemia. Regardless of whether you choose dietary supplements or supplements, follow the doctor’s advice and make good adjustments. You can basically get it back within 3 months at most. It’s not a big problem at all.