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"He looks pale," Grandma says worriedly. "Why won't he eat?" she asks with concern. "He's such a sleepy child, how can it be?" she adds. If some of her concerns are indeed accurate, your child may be among the 6-10 percent of Israeli children suffering from anemia.
Anemia is a decrease in the number of red blood cells or the concentration of hemoglobin in the blood. Since red blood cells contain hemoglobin, which carries oxygen to the body's organs, a deficiency in them can lead to various complications. Anemia can be caused by various factors, including destruction of red blood cells, blood loss, difficulty in producing red blood cells, infections, exposure to various toxins, types of cancer, and nutritional problems such as iron deficiency.
Iron deficiency is the primary cause of anemia among Israeli children aged six months to two years, and medical research has yet to find an explanation for the high prevalence of iron deficiency among Israeli children. Iron is essential for the production of hemoglobin, and poor nutrition can lead to anemia. Anemia caused by iron deficiency can occur at any age but is most common among children under two years old and adolescent girls.
Iron deficiency can impair a child's development, and according to findings from research conducted on the subject, there is concern about irreversible damage even after medical treatment with iron supplements for the child. Infants have particularly low iron absorption in their intestines, which varies according to their dietary sources and the amount of iron present in their food. For example, the amount of iron in breast milk is lower than the amount in various infant formulas, but the iron from breast milk is absorbed much more efficiently by the infant's body than the iron in infant formulas. When a child does not receive enough iron from their iron stores, they become depleted, leading to anemia (a decrease in hemoglobin) afterward.
Anemia has several identifying symptoms: general weakness, lack of appetite, fatigue, irritability, rapid heart rate, mood changes, and paleness of the skin, lips, and nail beds. These changes are usually gradual and difficult to identify. If anemia is caused by the destruction of red blood cells, symptoms may also include jaundice, yellowing of the whites of the eyes, enlarged spleen, and dark urine. Over time, prolonged iron deficiency can also affect cognitive development, concentration, functional development, and consequently delay physical development. Anemia can also affect the digestive system, leading to diarrhea or constipation. It is important to note that anemia may occur without any external symptoms, in a slow, progressive process that complicates disease identification. Therefore, it is customary in Israel to check the hemoglobin levels of every child from nine months to a year and a half old.
To diagnose anemia, a simple blood count test should be performed, which measures the child's hemoglobin level. Additional tests are available to measure the body's iron stores and can also identify anemia not caused by iron deficiency and iron deficiency that has not yet led to anemia.
The Ministry of Health recommends preventive treatment by giving iron supplements to children from four months to a year old. From 4 to 6 months, a daily dose of 7 mg (3 drops) is recommended, and from six months to a year old, the dosage should be increased to 15 mg (6 drops). It is recommended to administer the supplement separately and not with milk or tea because they interfere with its absorption in the body. Starting from six months old, in addition to taking the supplement, infants begin to transition from breastfeeding/bottles to solid foods, and it is recommended to ensure a diet rich in iron, such as chicken or turkey meat and vegetables. Other food products, like cereals, also add iron to the infant's diet.
It is important to note that these data refer to full-term infants born on time, meaning after a 40-week pregnancy. For preterm infants, the guidelines are different and depend on the cause of prematurity and their weight at birth. Premature infants may require different initiation times and dosages, which will be determined by the physician's special guidance.
If anemia occurs in adolescent girls due to heavy menstruation, hormonal treatment to reduce bleeding may be an option.
In cases of acute anemia, the possibility of blood transfusion, medical treatment for parasites (or their removal), and pharmacological treatment to stimulate bone marrow for additional blood cell production should be considered.
Anemic children tend to fatigue quickly, and caregivers should be informed to allow the child the necessary rest. In the case of an enlarged spleen, strenuous physical activity should be avoided for fear of splenic rupture. It is essential to maintain a suitable diet:
In the case of anemia, it is essential to perform continuous medical follow-up and periodic tests of hemoglobin levels in the blood.
