Anemia in children. Causes, symptoms, diagnosis and treatment of pathology

This type of anemia is the most common among young patients. It occurs in 40% of children under 3 years of age and in 30% of adolescents.

The reasons that provoke the development of iron deficiency anemia can be formed in the prenatal period and after the birth of the child.

In the antenatal period, the following factors can contribute to the development of the syndrome:

• delay in the development of iron depots in the fetus,
• toxicosis of the expectant mother, her anemia and infectious diseases,
• carrying twins or twins,
• premature birth,
• risk of miscarriage,
• early placental abruption, placental insufficiency,
• untimely ligation of the child's umbilical cord,
• lymphatic diathesis,
• large fruit mass.

Postnatal factors contributing to the development of iron deficiency anemia appear after the birth of a child, regardless of age. The main causes of iron deficiency in children's bodies are:

• lack of iron-containing foods in the diet,
• unbalanced diet,
• artificial feeding with cow's or goat's milk,
• use of unadapted infant formulas,
• late introduction of complementary foods,
• vegetarian food,
• bleeding (traumatic, nasal, gastrointestinal, menstrual),
• lack of transferrin in the body,
• allergies and infectious diseases.

Iron deficiency anemia can be a consequence of many childhood diseases:

• giardiasis,
• intestinal dysbiosis,
• intestinal infections,
• lactose deficiency,
• ulcerative colitis,
• Hirschsprung's and Crohn's diseases.

Symptoms

The clinical picture of iron deficiency anemia may vary depending on the associated syndromes.

• With astheno-vegetative syndrome, the child may experience tearfulness, enuresis, dizziness and fainting. At the same time, decreased muscle tone and a delay in mental and physical development (in severe forms and in intellectual development) are also noted.
• Epithelial manifestations refer to problems with the skin, nails and hair. With this form, the patient’s nails and hair become brittle, hyperkeratosis appears on the knees and elbows, cracks form in the oral cavity, the skin becomes very dry and can peel off.
• Dyspeptic signs of iron deficiency are loss of appetite, dysphagia, problems with stool, anorexia. With this syndrome, changes in taste and olfactory preferences are possible. There is a desire to eat earth or lime, and patients begin to like strong chemical odors.
• Myocardial muscle dystrophy, heart murmurs, low blood pressure, tachycardia and shortness of breath are functional disorders of the cardiovascular system due to iron deficiency.
• Immunodeficiency syndrome is expressed by subferal body temperature for a long time, regular infectious and clinical diseases, and severe infections.

Diagnosis of iron deficiency anemia in a child

To diagnose the disease, it is necessary to take a laboratory blood test. To identify the etiology, various studies may be prescribed:

• Ultrasound of internal organs,
• FGDS,
• x-ray,
• stool analysis,
• colonoscopy,
• irrigoscopy,
• brain puncture.

Complications

With timely and correct treatment of iron deficiency anemia, complete elimination of the childhood disease and normalization of iron levels in the blood are achieved.

If the syndrome becomes chronic, the sick child faces serious problems:

• retardation in physical and psychological development,
• delay in intellectual development,
• duration and severe form of infections and somatic diseases,
• increased morbidity due to weakened immunity.

Treatment

What can you do

If one or more of a set of symptoms manifests itself, it is necessary to contact a pediatrician, who, if necessary, will refer the patient to specialized specialists.

When confirming the diagnosis, it is important to follow all medical recommendations. First of all, this concerns the treatment of the underlying disease and the elimination of iron deficiency.

It is necessary to fully complete the course of medications and vitamins. The treatment course lasts about 4-6 weeks, another 3-4 months are needed for the maintenance course.

Only by taking tablets and vitamin-mineral complexes in the prescribed volume, regimen and duration can you get rid of not only the symptoms, but also the syndrome itself.

During and after treatment, it is important to follow the rules of nutrition, school activities and rest of the child.

What does a doctor do

After examination and receiving the results of a blood test, the pediatrician refers the patient to specialized specialists - hematologist, gastroenterologist, gynecologist, neonatologist, etc.

Specialized pediatric doctors can conduct additional diagnostic tests to identify the exact causes of the disease. After this, an outpatient course of treatment is developed.

Elimination of iron deficiency anemia is primarily based on adjusting the children's diet by including iron-containing foods. Depending on the type of clinical syndrome, medications and auxiliary drugs are prescribed.

The treatment course is divided into main (treatment of the underlying disease and normalization of the amount of iron) and supporting (normalization of the body’s functioning for the further correct course of processes associated with the production and transportation of iron).

Prevention

Prevention of childhood iron deficiency anemia can begin while the child is expecting. The expectant mother needs to maintain normal levels of iron and hemoglobin in her body by following a daily routine, proper nutrition and taking special multivitamin complexes for pregnant women.

After the baby is born, to prevent iron deficiency, feed him breast milk, but at the same time begin introducing complementary foods in a timely manner.

Be sure to include foods high in iron in your children’s diet:

• Buckwheat,
• oatmeal porridge,
• legumes,
• spinach,
• fruits - peaches and apples,
• dried apricots,
• egg yolk,
• fish,
• beef,
• veal and liver.

During adolescence (especially girls with the onset of their critical days), twins and premature babies, special vitamins or medications may be prescribed as preventive measures.

In the article you will read everything about methods of treating a disease such as iron deficiency anemia in children. Find out what effective first aid should be. How to treat: choose medications or traditional methods?

You will also learn how untimely treatment of iron deficiency anemia in children can be dangerous, and why it is so important to avoid the consequences. All about how to prevent iron deficiency anemia in children and prevent complications.

And caring parents will find on the service pages complete information about the symptoms of iron deficiency anemia in children. How do the signs of the disease in children aged 1, 2 and 3 differ from the manifestations of the disease in children aged 4, 5, 6 and 7? What is the best way to treat iron deficiency anemia in children?

Take care of the health of your loved ones and stay in good shape!

A pale, lethargic, poorly eating child is always a headache for the mother. This condition deservedly causes anxiety among parents and requires them to take certain actions, the first of which, of course, should be a visit to the pediatrician.

One of the reasons for such changes in appearance and behavior may be iron deficiency anemia in children, the symptoms of which are only the tip of the iceberg.

What it is

All organs and tissues in our body need oxygen. To ensure its uninterrupted delivery, the body contains a red blood cell - an erythrocyte. This is a cell in the form of a biconcave disk, the internal contents of which are rich in hemoglobin.

Hemoglobin is a red pigment containing iron that can bind with oxygen. The main store of iron inside cells is the protein-iron complex. It is found in almost all organs and tissues. Transferrins are proteins that transport iron from the site of its absorption from food in the duodenum to developing red blood cells.

When iron levels in the body drop, the amount of hemoglobin and red blood cells decreases. Iron deficiency anemia develops in the child, previously also called anemia.

How to suspect anemia

The lack of iron and oxygen leaves its mark and gives the child certain characteristics. Symptoms in children fall into several groups:

Anemic manifestations(due to insufficient oxygen supply to tissues):

• pallor,
• lethargy,
• fatigue,
• moodiness,
• learning disability
• headache,
• noise in ears,
• shortness of breath, palpitations,
• dizziness,
• darkening of the eyes and even fainting.

Enzymatic(due to a deficiency of iron, which is part of many enzymes, their work and metabolism are disrupted).

• Skin changes: this is dry skin, its peeling, over time the appearance of sticking on the lips, and in the later stages, cracks in the rectum and oral mucosa. At the same time, hair and nails become thin and brittle. Longitudinal stripes appear on the nail plates.
• Muscles become weaker and more fatigued. Growth and physical development may be delayed. The obturator muscle of the bladder cannot cope with its work, which leads to involuntary urination when laughing or coughing, the urge to urinate becomes uncontrollable and becomes more frequent. Possible bedwetting.
• The most dangerous manifestation of muscle damage is myocardial dystrophy, affecting the heart. This is exactly what they are afraid of, trying to start treating anemia as early as possible. It is associated with systolic murmur when listening to the heart, increased heart rate and possible complications in the form of chronic heart failure, which not only will not allow the child to play sports, but can also turn him into a disabled person.
• Smell and taste are distorted. The child may begin to eat unusual things that do not contain iron and do not compensate for its deficiency (chalk, watercolors, cardboard, flour, dry pasta). He may begin to like certain, sometimes strong, smells.
• Changes in the enzymatic activity of saliva tend to dental caries. Atrophy of the oral and pharyngeal mucosa makes swallowing difficult, the child may choke when eating.
• Atrophic processes begin in the mucous membranes of the stomach and intestines, which leads to loss of appetite, problems with bowel movements, slow weight gain.

It is for this reason that formula-fed infants often refuse formula by the fourth or fifth month. Mom, in a panic, begins to sort through different types of baby food. And the problem lies in the fact that in the rickets program the infant began to become anemic.

• The upper respiratory tract is also affected. In advanced cases, it is atrophic inflammation of the pharynx and larynx that becomes the cause of chronic pathologies of the ENT organs.
• Local and general immune response decreases. The child is more susceptible to viral, bacterial and fungal infections.
• Bluish tint to the whites of the eyes– the result of defective formation of collagen fibers.

How the disease develops and is diagnosed

In the early stages of the latent course of the disease, the iron depot is already depleted (low ferritin) and iron transport is impaired (low transferrins), but clinical manifestations are minimal:

• fatigue,
• slight shortness of breath,
• poor tolerance to physical activity.

An extensive clinic for iron deficiency anemia already includes any signs of anemia in children from anemic and enzymatic syndromes.

To establish a diagnosis, a general blood test is most often used:

• It determines the levels of red blood cells and hemoglobin. In the analysis form performed by the analyzer, they are designated as (RBC) and (HGB).
• Previously, there was also such a criterion as a color index (iron deficiency anemia was considered hypochromic), but today the diagnosis of anemia in children is based on the following indicators:
  • McV (mean red blood cell volume) and
  • McH (average hemoglobin content in a red blood cell).
    Their values ​​below normal correspond to hypochromic anemia. After starting treatment with iron supplements, they may be within normal limits. Then the anemia will be considered normochromic.

A biochemical blood test notes:

• decrease in ferritin, serum iron (<12,5 мкмоль на литр),
• increasing the total iron-binding capacity of serum (TIB >69 µmol per liter),
• transferrin saturation with iron will also be below normal (<17%).

Hemoglobin norms by age are given in the table:

Degrees of anemia in children

• mild anemia in a child - hemoglobin level 110 - 90 g/l;
• medium heavy – 90-70 g/l;
• heavy -<70 г/л.

The causes of anemia with iron deficiency in children fit into several groups.

The cause of anemia is a lack of iron intake

The child’s body should receive 0.5-1.2 mg of iron per day. From the moment of puberty, when the child rapidly catches up with adults in terms of weight parameters, 2 mg for boys and 4 mg for menstruating girls. A maximum of 2 mg of iron can be absorbed from food per day (10-15% of that received from food). Approximately one to one and a half grams of iron can be contained in the depot. Thus, the issue of iron intake must be broken down by age.

babies

For newborns and children up to one year old, the amount of iron that they accumulated at the time of birth is very important. In utero, iron is delivered to the fetus through the placenta. The peak activity of this process occurs from 28 to 32 weeks of pregnancy. By the time of birth, a full-term baby should accumulate 300-400 mg, and a premature baby at least 100-200 mg of the microelement. Therefore, it is so important that the mother eats right before the baby is born (red meat, vegetables, fruits) and promptly prevents or treats iron deficiency anemia in herself.

A newborn spends its supply on the formation of hemoglobin, enzymes, the construction of myoglobin, and partially compensates for losses with hair, epidermis, and sweat. The reserve is usually depleted in full-term infants by the end of the first six months of life, and in premature infants by the 3rd month (this is why anemia of premature infants is so common). The faster a baby grows and develops, the greater its need for iron. And here the issue of feeding comes first.

Anemia in children under one year of age is almost always associated with the incorrect selection of a breast milk substitute and unjustifiably late complementary feeding or its inadequacy. It's worth remembering that:

• Breastfeeding is preferable, since its composition is maximally adapted to the enzymatic capabilities of the baby; the ratio of phosphorus and calcium does not interfere with the absorption of iron and reduces the risk of rickets, which also contributes to the development of anemia.
• Artificial feeding should always be supplemented with preventive doses of vitamins D3 to avoid rickets and anemia.
• Neither cow's nor goat's milk can be considered a substitute for breast milk. When selecting artificial nutrition, the choice should be towards adapted mixtures. Early introduction of dairy products leads to microdamage to the intestines, which begins to bleed and increase iron loss. The introduction of kefir is allowed from 9 months, and milk not earlier than a year.
• After six months, the child should receive complementary foods (starting with vegetables or cereals, including red meat). In general, a child from six months to a year needs 11 mg of iron in his diet (only 10-15% of it is absorbed). Tactics for introducing meat complementary foods can be different. For children with pre-existing anemia, meat is introduced as early as possible (at 6-7 months). As an option, they give ready-made porridges fortified with iron, adding meat at 8 months. Part of the problem of iron intake can be solved by introducing egg yolk into the diet (at 8 months). If it is not possible to compensate for iron deficiency with nutrition, additional iron supplements are given.

From one year to three

Anemia in young children is also a common result of improper nutrition. At 2 and 3 years old, a child often shows character and food preferences: he refuses certain dishes or types of food, is stubborn, or strives only for sweets.

Everyone knows stories about kids who, according to their mother, eat only cookies or who completely give up meat in favor of sausages or dumplings. However, if complete animal protein, red meat or eggs are not present on the baby’s table, additional drug prevention of iron deficiency anemia will be required.

A child under three years of age needs food per day 7 mg iron.

The problem can be partly solved by using the same store-bought cereals with added iron or special fortified children's cookies. Unfortunately, the myths that green apples, buckwheat or parsley can provide the body with enough iron are just that: myths.

Vegetables and fruits in the diet are designed to provide us with ascorbic acid, which enhances the absorption of iron. Red meat myoglobin remains the optimal source of iron in terms of availability and digestibility.

Vegetarianism is a conscious choice of an adult who is free to manage his life and health, but involving a growing child in it is at least frivolous.

For older people

Older children, including teenagers, should also have a balanced diet. For them, the iron content in food should be from 5 to 15 mg.

Disturbances in iron transport due to transferrin defects can also be attributed to disturbances in the supply of microelements.

Iron loss

This category may include acute and chronic bleeding. With the exception of massive blood loss resulting from trauma, not all bleeding can lead to anemia.

If a child breaks his lip, is scratched, or even cuts his finger, it is highly likely that the supply of iron in the depot will allow him to compensate and avoid anemia. Chronic blood loss should be more significant, for example, with minor hemorrhages in the intestines:

• against the background of bacterial intestinal infections,
• diets,
• fissures in the anal area,
• with peptic ulcer of the stomach or duodenum.

This is especially significant for children at risk of anemia:

• with a lack of iron intake,
• premature,
• children from birth to.

Helminthiases can lead to damage to the intestinal mucosa and minor chronic bleeding. Hookworms, necators, and whipworms directly feed on blood from the intestinal wall. and their larvae cause mechanical damage to the mucosa.

Girls who start menstrual bleeding deserve special attention. They require the administration of iron supplements for the entire period of bleeding in a therapeutic dosage as the primary prevention of anemia.

Malabsorption

This item includes all problems associated with fermentopathy and intestinal diseases that impede the absorption and transport of iron. Here are the syndromes of maldigestion and malabsorption in chronic colitis, nonspecific ulcerative colitis and Crohn's disease, in the program of infectious enterocolitis, dysbacteriosis (syndrome of increased bacterial colonization of the intestines), cystic fibrosis. Lesions of the duodenum 12 (duodenitis, giardiasis).

overspending

Premature babies are at risk due to the immaturity of the hematopoietic organs and the poorer reserves they receive at birth.

Fast-growing children of all ages from infants to teenagers also need more micronutrients.

Previously, the consumption of iron in foci of inflammation in chronic diseases of the ENT organs, respiratory, digestive systems, kidney and urinary tract diseases, oncological pathologies, and pruritic dermatoses was also classified as iron deficiency anemia. Today, this condition is classified as anemia of chronic diseases and is considered a separate disease.

How to treat

The main goals of treatment of iron deficiency anemia in children are to eliminate the causes of iron deficiency, restore hemoglobin and red blood cell levels, and saturate the microelement depot. Therefore, it is fundamentally wrong to simply give a child iron-containing drugs until the levels of hemoglobin and red blood cells in blood tests reach the age norm.

Organizing a balanced diet taking into account the needs of the child, ridding him of infectious foci, helminths, inflammatory diseases and fermentopaias, primary and secondary prevention (after treatment in children) are key areas that should be combined with the prescription of drugs.

• The diet should contain animal proteins (red meat, beef, liver, fish, poultry, cottage cheese), vegetables and fruits, and dairy products that improve iron absorption.
• Legumes, nuts, strong tea and coffee are limited, as they interfere with the absorption of iron from the intestines.

When choosing drugs, an advantage is recognized for forms for oral administration (drops, tablets, capsules, syrups). These forms replenish iron deficiency more naturally than injections.

Since it is also necessary to saturate the depot, anemia:

• Grade 1 in a child (mild) requires a course for 3 months,
• moderate severity – 4.5 months,
• heavy – six months.

If iron deficiency anemia has developed in children, it is rational to treat with drugs containing ferric salts, which allow the required dose to be given from the beginning of treatment. They do not irritate the intestines and are better tolerated than ferrous iron.

What preparations contain 3 valent iron?

The child should receive these medications depending on the purpose of therapy (Federal clinical guidelines for the management of anemia in children):

• for the treatment of anemia at a dose of 5 mg per kg of body weight per day.
• for sideropenic syndrome (latent iron deficiency) half the calculated dose.
• for the prevention of iron deficiency in children under 3 years of age - 1.5 mg Fe per kg. weight of a child over 3 years old - 1/2 of the therapeutic dose.

Ferrous preparations

To calculate the doses of these drugs, not only the weight, but also the age of the child is taken into account.

• Up to 3 years – 3 mg per kg of body weight per day,
• Over 3 years – 45-60 mg per day,
• Teenagers up to 120 mg per day.

Medicines are prescribed in dosage and form of administration depending on the age of the child:

Indications for injection therapy

• Severe form of anemia.
• Intolerance to tablets, syrups or oral solutions.
• Lack of effect from treatment with oral medications.
• The presence of gastric or duodenal ulcers or operations on the gastrointestinal tract.
• Chronic bowel diseases (UC, Crohn's disease).
• Renal failure before or during dialysis.
• Contraindications or parental refusal to receive red blood cell transfusion.
• For quick saturation with iron.

If severe anemia develops, which occurs in no more than 3% of cases, treatment in children may require a red blood cell transfusion.

How to evaluate the effectiveness of treatment?

• By the 3rd week of therapy, reticulocytes in the blood test increase, and hemoglobin can increase either smoothly or spasmodically.
• At 3-4 weeks, hemoglobin should increase in the blood.
• After 2 months, the symptoms of anemia in the child should also decrease.

After normalization of hemoglobin, it is impossible to abruptly stop treatment, since hemoglobin will decrease quite quickly again. If medications are stopped early, relapses of anemia occur in the coming months. Therefore, after restoration of hemoglobin in the blood, therapy is continued at 1/2 of the therapeutic dose.

One of the main signs of the effect of taking iron supplements is the disappearance or reduction of muscle weakness. This is because Fe is part of the enzyme complexes involved in muscle contraction.

What side effects are possible when taking it?

When taking iron supplements, the stool becomes black. This is normal and not dangerous. After discontinuation of the drug, the color of stool returns to normal within 2-3 days.

During treatment, side effects may develop, which in some cases require changing the drug, dose or changing the frequency of administration:

• Salt forms of drugs at the beginning of taking them can loosen the stool. Therefore, they start taking it with 1/4 or 1/2 of the calculated dose for 2 weeks; the rate of increasing the dose to the therapeutic dose depends on the state of the child’s gastrointestinal tract and the level of iron deficiency.
• Preparations of 2-valent Fe interact in the gastrointestinal tract with food and liquids, which complicates the absorption of iron. Therefore, they are taken an hour before meals.
• Preparations of 3-valent Fe do not require changes in initial dosages, because food does not affect the absorption of iron and their intake is indicated in full dose, regardless of food intake.

When should you give preventative medications?

Prevention of anemia in children is carried out according to the following schemes:

• Full-term infants who are breastfed or mixed (at least 2/3 breastfeeding) from 4 months before the introduction of the first complementary foods additionally need 1 mg of iron per kg of body weight per day.
• Artificial formulas enriched with iron do not require medications. Those who eat mixtures with low iron content - the tactics from the previous paragraph.
• Premature babies with natural feeding need 2 mg of iron per kg of body weight per day from 1 month before the introduction of complementary foods or until transfer to iron-fortified formulas.
• Prevention is mandatory for menstruating girls with any oral drug in a therapeutic dose throughout all days of menstruation.
• Children with a high risk of anemia (low socioeconomic status, vegetarianism, allergies to animal protein, gastrointestinal diseases, rapid growth, etc.) should undergo a screening survey and a finger prick test once a year.

After an episode of anemia, the child is under clinical observation for a year.

Prescribing treatment and choosing medications is the job of a competent pediatrician. The mother’s tasks include organizing a balanced diet for the baby and promptly contacting a doctor if a disease is suspected.

Most often, in 80% of cases we are faced with nutritional anemia (insufficient dietary intake of iron or vitamins and protein that facilitate its absorption).

Causes of IDA

Antenatal causes (iron deficiency begins in utero). Antenatal causes can be “provoked by IDA in children under 1.5 years of age. It should be remembered that iron in the body tends to be deposited, that is, stored in special depots (mainly in the liver). If the body requires increased consumption of iron (for example, illness, stress and other increased loads), it receives it from the depot. In a child who has not received enough iron in utero, iron depots are not formed. At the same time, the level of hemoglobin in the blood may be normal, but its deficiency will immediately affect if any situation traumatic to health occurs.
Iron deficiency in infants can be caused by:

• frequent pregnancy in the mother;
• history of abortion;
• multiple pregnancy (twins);
• toxicosis of a pregnant woman, anemia of a pregnant woman, infectious diseases of a pregnant woman;
• maternal bleeding during pregnancy and childbirth;
• prematurity;
• quick ligation of the umbilical cord, etc.

Insufficient iron intake to the fetus has a particularly bad effect in the last 2 months of pregnancy, when the depot is being formed. For the same reason, premature babies often suffer from anemia, since they do not have time to form an iron depot. During pregnancy, a woman's iron requirement is 4 mg per day.
Postnatal anemia. Associated with reasons that arose after the birth of the child.
Insufficient intake of iron from food (nutritional factors). Predisposing factors may be:

• early artificial feeding;
• late introduction of complementary foods;
• long-term one-sided (milk) feeding;
• vegetarian diet, devoid of animal protein.

Anemia can be caused not only by iron deficiency, but also by a deficiency of microelements such as zinc and copper, as well as vitamins B, B2, B6, PP, C, and especially B2 and folic acid (B12-deficiency, folate-deficiency anemia). Vitamin B2 deficiency leads to premature maturation of red blood cells. Functionally immature erythrocytes of huge shape (megalocytes), with a shortened life span, cannot provide adequate oxygen transport to tissues and are quickly destroyed. This form of anemia is called B12-deficient, folate-deficiency anemia.
Accelerated body growth. Iron deficiency may be associated with rapid growth of a child during the pre-teen and teenage periods. At this time, blood circulation does not have time to provide for a rapidly growing organism and is “delayed.” An important role is played by the discrepancy between the physiological needs of a growing organism and the amount of iron supplied with food.

Various diseases:

• Impaired absorption of iron in the intestines. The cause may be dysbacteriosis, cystic fibrosis, malabsorption syndrome, lactose deficiency, celiac disease, low acidity of gastric juice, duodenitis, intestinal infection, lamblia.
• Liver diseases.
• Chronic blood loss. Causes: polyposis, thrombocytopenic purpura, nosebleeds, erosive gastritis, worms, intolerance to cow's milk protein, heavy menstruation in girls, etc.
• Infectious diseases can cause IDA due to the fact that iron is actively involved in the formation of immune defense cells, phagocytes. Each infection is accompanied by high fever, intoxication, and a restructuring of the immune system, leading to disruption of the distribution of iron in the body (decreased iron in the blood plasma), since during illness it is more important for the body to form an adequate immune response.

In addition, bacteria and viruses use iron to feed and reproduce, which makes iron deficiency worse. Therefore, during acute inflammation, the child’s blood hemoglobin may be reduced. And this is completely justified during the illness and does not cause serious concern, since after recovery its level will be restored.
Taking certain medications: analgin, amidopyrine, cytostatics.

Diagnosis of IDA

The diagnosis of IDA is made based on clinical and laboratory data. A special history, clinical picture and general blood test almost always provide complete information about the disease.

Clinical manifestations:

• Paleness of the skin and mucous membranes.
• Increased fragility of hair and nails.
• Sadness in the eyes. Dark circles under the eyes.
• Decreased muscle tone.
• Perversions of appetite and smell.
• Atrophic glossitis (“red cardinal tongue”).
• Decreased immunity.
• Memory loss. Decreased performance at school.
• Dizziness, frequent headaches, fainting.
• Restless sleep, difficulty falling asleep, emotional lability, tearfulness.
• Gastritis accompanied by vomiting. Laboratory data:
• A decrease in blood hemoglobin below PO g/l and the number of red blood cells in a clinical blood test below 3.8 x 10 12.

The severity of anemia is determined depending on the level of these parameters.

Easy-degree: hemoglobin 90-110 g/l, red blood cells 3.8 - 3.0 x 109.
Average degree: hemoglobin 70-90 g/l, red blood cells 2.5 - 3.0 x 1012.
Severe degree: hemoglobin is below 90 g/l, red blood cells are below 2.5 x 1012.

• Blood serum examination (biochemical blood test): decrease in the level of iron, total protein, iron transport proteins (transferrin, ferritin), total iron-binding capacity of the blood and latent iron-binding capacity of the blood.
• Desferal test. Determination of the amount of iron excreted in the urine.

If anemic syndrome is detected, you should consult a doctor. It should be remembered that a decrease in hemoglobin and red blood cells can be a consequence not only of other forms of anemia, but also of such serious diseases as oncological processes and acute leukemia.
The course of the disease is such that at the beginning the blood picture (hemoglobin and red blood cell levels) may be normal, but there will be iron deficiency. First, there will be a deficiency in the depot, and then iron deficiency can be detected in the blood serum (biochemical blood test). This is called hidden, latent, iron deficiency: deficiency with a normal blood picture. As the process progresses and the body continues to lack iron, the deficiency becomes permanent. With constant iron deficiency, the blood picture changes: the hemoglobin level and the number of red blood cells drop.
Treatment of hidden, latent iron deficiency is possible by adjusting the diet and prescribing vitamins. Persistent, obvious iron deficiency requires mandatory prescription of iron supplements in addition to diet therapy.
Treatment of IDA should always begin with eliminating its cause and organizing the correct regimen and nutrition.

Diet for IDA

Foods containing iron primarily include meat, especially white chicken, liver and organ meats. Legumes (peas, beans) have a high iron content, especially soybeans. There is a lot of it in parsley, spinach, dried apricots, prunes, raisins, apples, and pomegranates. But iron is best absorbed from animal products (meat). Iron is absorbed worst from plant foods. When absorbed from plants, insoluble iron complexes are formed that are poorly absorbed by the body. For example, only 1% of iron is absorbed from rice and spinach, 3% from corn, beans, fruits, eggs, and 11% from fish. While 22% of iron is absorbed from veal and beef. A good combination is provided by eating meat with plant products. At the same time, plant iron does not form insoluble compounds and is better absorbed.
Tannin (tea) and dairy products reduce iron absorption. Ascorbic acid (vitamin C) and sugar increase the absorption of iron. Therefore, iron supplements should not be taken with milk or tea, but preferably with pulpy juices.
Conclusion: do not try to increase hemoglobin by feeding your child pomegranates, apples and buckwheat porridge. In order for enough iron to be absorbed, you need to eat such amounts of these foods that no child can eat. The leading product in diet therapy for IDA is meat.
Human milk contains approximately the same amount of iron as cow's milk, but its absorption level is much higher. During the first 3 months of life, about 80% of iron is absorbed from breast milk, and only 10% from cow's milk. In addition, cow's milk casein contained in formulas for artificial feeding is not physiological for the baby's gastrointestinal tract. Consumption of cow's milk (including from formula) contributes to the development of dysbiosis and can cause food allergies, accompanied by damage to the intestinal walls with additional loss of iron. This reduces the absorption of iron in the intestines and can cause or worsen anemia. Early transition to artificial feeding is a risk factor for the development of anemia.

Prolonged breastfeeding without correction and timely introduction of vegetable, fruit purees and meat into the child’s diet is also dangerous.
Millet, pumpkin, strawberries, raspberries, bananas, dark grape varieties, watermelon, rose hips, melon, cabbage, radish, watercress, onions, garlic, walnuts, chicory, and stinging nettle are also useful for anemia. They contain the necessary microelements and vitamins to restore normal hematopoiesis.
To restore folic acid deficiency in folate deficiency anemia, it is recommended to eat corn, black currants, lettuce, cauliflower, and apples.

Treatment of IDA

I. Iron supplements. Prescribing iron supplements, choosing the dose and course of treatment is the doctor’s priority. The dose and course, as well as the route of administration of the drug (orally, intramuscularly) are selected depending on the form of anemia, severity, and individual characteristics of the patient.

Rules for taking iron supplements:

• The course of treatment begins with 1/4 dose of the drug and is increased to the full dose within a week.
• Treatment with iron supplements must be continued after normalization of hemoglobin levels in the blood to form an iron depot. A maintenance dose is usually prescribed for another 1 - 1.5 months. at half the therapeutic dose.
• Iron supplements are taken between meals, 1.5 hours before or 1.5 hours after meals. Take iron with pulpy juices or water, but not with milk or tea.
• To enhance absorption efficiency, ascorbic acid, succinic acid and other vitamins are prescribed along with iron.

Side effects possible when taking iron supplements:

• From the digestive system: rarely - a feeling of fullness, pressure in the abdomen, nausea, constipation or diarrhea.
• Possible dark coloration of stool due to the release of unabsorbed iron (safe for the body).
• Darkening of tooth enamel.
• Headache, dizziness, redness of the skin, toothache, sore throat, weakness, feeling of pressure behind the sternum, irritability.
• Allergic reactions are possible.

Contraindications for taking iron supplements:

• Hemosiderosis, impaired iron utilization.
• Non-iron deficiency anemia (hemolytic, megaloblastic, caused by a lack of vitamin B2).
• Lead poisoning.
• Individual intolerance.

II. Vitamins:

• Succinic acid. Prescribed 50-150 mg per day. Succinic acid significantly improves the absorption of iron (by 30%).
• Ascorbic acid (vitamin C).
• B vitamins.
• Complex drugs: milgamma, multitabs B-complex, alvitil, neuromultivit, undevit, etc.
• Vitamins PP, B6, folic acid and B12 are used as monotherapy at the discretion of the doctor.

III. Microelements. There are often cases when the use of iron supplements does not restore hemoglobin levels. In these cases, iron deficiency may be due to a deficiency of other important microelements. Microelements involved in hematopoiesis include zinc, manganese, chromium, copper and cobalt. In modern conditions, zinc deficiency is leading. They are produced both in the form of single preparations (zinc oxide, zincteral) and in complexes in combination with multivitamins (alphabet, duovit, undevit, etc.). The totem preparation contains copper and manganese in combination with iron.

IV. Adaptogens. They have a stimulating effect, increase resistance to infections, and activate the nervous system.
Tinctures of eleutherococcus, aralia, Rhodiola rosea, ginseng. 1-2 drops per year of the child’s life in the morning for 2-3 weeks.

V. Herbal medicine.
Iron contains: infusion of dandelion, hawthorn, valerian, currant.
Copper: infusion of hawthorn and valerian.
Zinc: mountain arnica, bird's eye, birch leaves, anise, hawthorn, valerian, rose hips.
Cobalt: infusion of hawthorn and valerian, rosehip decoction.
The herbal preparations contain dosages calculated for an adult.

Herbal collection No. 1 (to restore hematopoiesis after blood loss): shepherd's purse grass 4 parts, rose hips 2 parts, burnet root 3 parts, primrose leaves 2 parts, nettle leaves 2 parts, corn silk 3 parts, yarrow herb 2 parts.
Brew 1 tsp. collecting 200 ml of boiling water. Leave until cool. Drink throughout the day before meals.

Herbal collection No. 2 (for heavy menstruation in girls): knotweed grass 4 parts, clover grass 2 parts, sweet clover grass 1 part, lemon balm leaves 2 parts, agrimony grass 3 parts, birch leaves 2 parts, licorice root 1 part.
Brew 1 tsp. collecting 200 ml of boiling water. Leave until cool. Drink throughout the day before meals. The course of treatment is 2-6 months under medical supervision.

Herbal collection No. 3 (for anemia): nettle leaves 4 parts, knotweed grass 2 parts, agrimony grass 2 parts, birch leaves 2 parts, anise fruit 1 part, plantain leaves 3 parts.
Brew 1 tsp. collecting 200 ml of boiling water. Leave until cool. Drink 1/3 glass before meals 3 times a day.

VI. Homeopathic remedies. Homeopathic treatment gives very good results for anemia. There are also complex homeopathic preparations for the treatment of anemia.
Ubiquinone compositum. A complex homeopathic preparation that has a general tonic, antioxidant, and immunostimulating effect. Indicated for chronic diseases caused by metabolic disorders, hypovitaminosis, asthenic and hypoxic conditions due to increased physical and mental stress, etc. (as part of complex therapy).
Contraindications: hypersensitivity to the components of the drug, infancy.
Side effects: allergic reactions.
Application: intramuscularly 2.2 ml 1-3 times a week.
To the poets. Complex homeopathic medicine. Used to treat various forms of anemia, including in patients with chronic renal failure, after cytostatic chemotherapy and/or radiation therapy, with anemia due to infectious (including viral) diseases, due to toxic effects.

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