Anemia in children

Anemia in children is a pathological condition characterized by a decreased content of hemoglobin in the blood.

The most common causes of anemia in children are nutritional deficiencies in the body and a lack of iron. Normal indicators of hemoglobin level in the blood of a child under the age of about six years are 125-135 grams per liter, the last permissible limit is 110 g / l.

An increased risk of anemia incidence exists primarily for children born with preterm or multiple pregnancy, as well as suffering from any concomitant bowel disease. The highest incidence rate is observed in children under three years of age, due to the insufficient maturity of the organs of the hematopoiesis system and their increased susceptibility to negative environmental effects. Most often at an early age there is iron deficiency anemia.

According to the World Health Organization, this form of anemia occurs in about 20-25% of all newborns. Among children under the age of four, forty-three percent, five to twelve-thirty-seven percent. Also, experts believe that latent iron-deficiency anemia is more common, not accompanied by clinical manifestations. In order to prevent anemia, it is recommended to eat fully and in a balanced manner, often to be outdoors, to actively move, to get the necessary amount of vitamins and trace elements.

[1], [2], [3], [4], [5], [6]

Causes of anemia in children

• Shortage in the body of substances responsible for the production of hemoglobin.
• Various pathological processes associated with abnormalities of the intestinal tract, in particular, with a violation of absorption of nutrients, which are necessary for the production of hemoglobin.
• Deviations in the functioning of the hematopoietic system in the bone marrow.
• Anatomical and physiological immaturity of the organs of the hematopoietic system.
• Negative impact of unfavorable ecology.
• The presence of worms.
• Increased incidence.
• Disturbed and unbalanced diet and diet.
• Shortage in the body of trace elements, in particular, iron, copper, manganese, cobalt, nickel, as well as vitamins of group B and C, folic acid.
• If the child was born much earlier than expected time (with premature pregnancy).

[7], [8], [9], [10], [11],

Symptoms of anemia in children

Symptoms in anemia in children are classified according to the type and severity of the disease. A number of symptoms are common to all types of anemia. At the same time, some of its types can cause various accompanying symptoms. Differentiate symptoms and diagnose the disease can only be a qualified specialist. The most common symptoms of anemia in children are the following:

• Pale skin.
• Tachycardia.
• Dyspnea.
• Feeling of noise in the ears, dizziness, headache.
• Fast fatiguability.
• General state of weakness, lethargy.
• Poor appetite.
• Taste disorders (for example, a child can eat chalk).
• Fragility of hair and nails.
• Muscle weakness.
• Deterioration of the appearance of the skin (for example, rough surface of the skin).
• Yellow shade of skin.
• Compaction and enlargement of the liver and spleen.
• Frequent infectious diseases.
• Nose bleed.

Deficiency anemia in children

Deficiency anemia in children is the result of a lack of substances in the body that contribute to the formation of hemoglobin. They are more common among children under the age of one year. One of the most common deficiency anemia is alimentary anemia. As a rule, it arises as a result of malnutrition, associated with inadequate intake of substances that are necessary for the full growth and development of the child, for example, when there is a lack of protein or iron. Deficiency anemia can occur in diseases associated with impaired absorption of substances in the intestines, contribute to their development can also weakened immunity (increased incidence) and prematurity of the child during pregnancy.

[12], [13], [14], [15],

Iron deficiency anemia in children

Iron deficiency anemia in children is divided into the following forms:

Asthenovegetative

This form of anemia occurs as a result of impaired brain function, manifested in the form of insufficient development of psychomotor functions. A child with an asthenovegetative form of anemia, as a rule, is irritable, his attention is distracted, memory, night urinary incontinence, muscle pain, hypotension can occur.

[16]

Epithelial

Symptomatic of the disease includes dystrophy and atrophy of mucous membranes, skin, as well as nails and hair. The child, as a rule, has a bad appetite, heartburn, eructation, nausea, flatulence, swallowing disorders, the absorption process in the intestine is disrupted, with a very small level of hemoglobin, the pale skin and conjunctiva can be noted.

[17], [18], [19], [20], [21]

Immunodeficiency

With this disease, there are frequent acute respiratory viral infections, as well as intestinal pathologies of an infectious nature. In most cases, children with this disease have reduced iron in the blood plasma, weakened protective functions of the body.

Cardiovascular

This form occurs with severe iron deficiency anemia. The child quickly becomes tired, his blood pressure is lowered, palpitations are observed, systolic murmurs are heard, dizziness may occur.

[22], [23], [24], [25], [26], [27],

Hepatolienal

The most rare form of anemia, which usually occurs against the background of rickets and severe iron deficiency.

B12 anemia in children

B12 anemia in children is characterized by the formation in the bone marrow of anomalous cells of very large size, the destruction of erythrocytes within the bone marrow, a low platelet count, which leads to increased bleeding and difficulty in stopping bleeding. Also, with B12-deficiency anemia, a sharp drop in neutrophil blood can occur, which is extremely dangerous for life. With acute vitamin B12 deficiency, there are disorders in the mucosa of the gastrointestinal tract, nervous disorders develop. Insufficiency of vitamin B12 often occurs with impaired production of glycoprotein, which is responsible for its normal assimilation.

The disease can make itself felt after the transferred enteritis or hepatitis, which is associated with a violation of absorption of vitamin B12 in the small intestine or with its complete excretion from the liver. Clinical manifestations of anemia in 12 are the violation of the functions of the hematopoietic system, as well as the nervous and digestive system. With fiznagruzki there is a tachycardia, the child quickly gets tired, becomes listless. On the part of the digestive tract, oppression of gastric secretion, the absence of hydrochloric acid in the gastric juice. The tongue can feel burning, the skin acquires a yellowish color, the spleen (sometimes - the liver) is slightly enlarged, the level of bilirubin is raised in the blood. For treatment, administration of cyanocobalamin is given once a day for one to one and a half months. After the onset of improvement, the drug is administered once every seven days for two to three months, then twice a month for six months. After stabilizing the condition for preventive purposes, vitamin B12 is prescribed for administration once or twice a year (five to six injections).

[28], [29], [30], [31],

Hypochromic anemia in children

Hypochromic anemia in children occurs as a result of a decreased level of hemoglobin in erythrocytes. Diagnosis of the disease is carried out on the basis of a general blood test with the determination of the number of red blood cells and the level of hemoglobin, as well as the values of color characteristics. In hypochromic anemia, a low level of hemoglobin in all cases is combined with a decrease in color indices. The size and appearance of red blood cells also affect the diagnosis. With hypochromic anemia, red blood cells have a rounded shape, dark edges and a light spot in the middle. Hypochromic anemia is divided into iron deficiency, iron-saturated, iron-redistributive and anemia of mixed type. The symptomatology of the disease depends on its shape and can include such symptoms as general weakness, dizziness, slowing of mental and physical functions, tachycardia, pale skin, etc. As an auxiliary treatment in alternative medicine, the following remedy is used: a glass of freshly squeezed pomegranate juice is mixed with lemon, apple and carrot juice (in the proportions of one hundred milliliters), add fifty-seventy grams of natural honey, mix thoroughly and take two tin spoon three times a day in the form of heat. Ready mixture should be kept in the refrigerator, before taking it is necessary to make sure that there are no allergic reactions and to consult a doctor.

Aplastic anemia in children

Aplastic anemia in children refers to the type of hypoplastic anemia and is the most common form. When the bone marrow is affected, the functions of the hematopoietic system are violated, the level of leukocytes, platelets and erythrocytes is reduced. The etiology of the disease is usually associated with infectious or toxic effects on the bone marrow. Aplastic anemia often develops spontaneously and is acute. The skin becomes pale, the nose is bleeding, touching under the skin creates bruises, a temperature reaction may occur. With these symptoms, immediate medical attention is needed, since this disease is characterized by a fairly rapid progression. In most cases, the treatment requires chemical therapy and transfusion of a red blood cell suspension obtained from whole blood by removing the plasma in order to normalize the functioning of the bone marrow. In the absence of a positive effect, bone marrow transplantation may be necessary.

[32], [33], [34], [35]

Hemolytic anemia in children

Hemolytic anemia in children is characterized by excessive destruction of erythrocytes and can be hereditary or acquired. With hereditary anemia, there is an increased destruction of red blood cells with the release of hemoglobin from them. Defective erythrocytes can remain viable for eight to ten days and are destroyed, mainly in the spleen. The first signs of the disease can manifest immediately after birth or show up at any other age. With hemolytic anemia, the skin becomes yellow, becomes pale, there is a delay in physical, and in some cases, mental development. The spleen and liver can be enlarged and compacted. Crises that occur in this disease can last seven to fourteen days and are accompanied by a temperature reaction, headaches, a sharp decline in strength, muscle weakness, decreased motor activity, etc. To remove or alleviate the symptoms of the disease, surgical intervention to remove the spleen can be performed.

Anemia in children under one year of age

Anemia in children up to a year is divided into anemia of newborns, anemia of prematurity, alimentary anemia due to malnutrition, post-infection anemia and severe anemia of Yaksh-Gayema.

Alimentary anemia is observed at the age of up to six months and is a consequence of a lack of iron, salt, vitamins and proteins. In most cases, it occurs when there is no breastfeeding. The development of anemia manifests itself in the form of deterioration of appetite, pallor of the skin, muscle weakness. The stool masses are dry or clay, and the liver can be slightly enlarged. The child is sluggish, quickly tired, jaundice can occur. With a severe form of the disease, mental and physical conditions are violated, the skin becomes excessively pale, there is an increase in lymph nodes, a liver, the body temperature rises, a noise is heard in the heart, and dyspnea appears. The level of hemoglobin decreases sharply, while the levels of red blood cells can remain normal. With iron deficiency, it must be included in the diet. Treatment of the disease is aimed at correcting nutrition and eliminating the causes that cause it.

[36], [37], [38], [39]

Anemia in premature infants

Anemia in preterm infants occurs in about twenty percent of cases, with much more frequent in the infancy. The degree of severity of anemia is directly related to the gestational age of the child, which corresponds to the gestation period - the smaller it is, the harder the disease progresses. In the first few months after birth, premature infants weighing less than one and a half kilograms and gestational age less than thirty weeks, in approximately ninety percent of cases, a red blood cell suspension is required. Anemia in premature infants is characterized by a progressive decrease in hemoglobin (ninety-seventy g / l or less), a decreased level of reticulocytes (preceded by erythrocytes in the process of hematopoiesis) and oppression of the functions of the hematopoiesis of the bone marrow. Distinguish between early and late anemia in premature infants. The first, as a rule, develop in the fourth-tenth week after birth. The level of reticulocytes is less than one percent, the maximum level of hemoglobin is seventy-eighty g / l, the hematocrit value is reduced to twenty to thirty percent. Symptoms of anemia in premature babies coincide with the symptoms of general anemia and can manifest as a pallor of the skin, rapid heartbeat, etc. In the development of anemia of premature infants, the shortage of folic acid, vitamin B6, trace elements such as zinc, copper, selenium, molybdenum, as well as the negative impact of infectious agents. Late anemia in preterm infants occurs approximately at the age of three to four months. The main symptoms of this disease are deterioration of appetite, pallor and dry skin, mucous surfaces, increase in the size of the liver and spleen, there is an acute shortage of iron.

[40], [41], [42]

Degrees of anemia in children

The degree of anemia in children is divided into light, medium and heavy. At a mild degree the child becomes inactive, sluggish, his appetite decreases, the skin turns pale, the level of hemoglobin and red blood cells decreases slightly. With anemia of moderate degree, activity decreases significantly, the baby does not eat well, the skin becomes dry and pale, the heart rate increases, the heart rate increases, the liver and spleen become thickened and enlarged, the hair becomes thinner and brittle and brittle, the systolic murmur is heard, the hemoglobin and erythrocyte levels decrease. With a severe form of the disease, there is a lag in physical development, muscle weakness, painful thinness, problems with bowel movement, excessive dryness and pale appearance of the skin, fragility of nails and hair, swelling of the face and legs, irregularities in the cardiovascular system, a decreased saturation of red blood cells hemoglobin with color indices less than 0.8.

[43], [44],

Anemia of mild degree in children

Anemia of mild degree in children may not have pronounced clinical symptoms, while the existing iron deficiency provokes further development and complication of the disease. In such cases, timely diagnosis helps prevent the progression of the disease. However, it should be noted that in some cases, clinical symptoms with mild anemia can be expressed even more than with a severe form. For the diagnosis it is necessary to take into account such factors as the level and average volume of erythrocytes, the color characteristics, the content and concentration of hemoglobin in erythrocytes, the presence of iron in the blood serum, etc. There is a simple method for determining iron deficiency at home. If after consumption of beets, the urine acquires a pink tint, most likely, there is a lack of iron in the body. In that case, consult a doctor.

[45], [46], [47], [48],

Anemia of 1 degree in children

Anemia 1 degree in children is characterized by a decrease in the level of hemoglobin to one hundred-eighty grams per liter of blood. At this stage of the disease, the external signs of anemia may be absent or the pallor of the skin and lips may be observed. To correct the condition after the conducted examinations, the attending physician prescribes therapeutic nutrition and iron preparations.

[49], [50], [51], [52], [53]

Anemia of 2nd degree in children

Anemia of the 2nd degree in children is manifested in the form of a drop in the hemoglobin level below eighty grams per liter. With such a degree of the disease, the child may lag behind in mental and physical development, the digestive tract, cardiovascular system, dyspnea, palpitation, dizziness may occur, the child often gets sick, feels weak and weak. In such cases, inpatient treatment is recommended under strict medical supervision.

[54], [55], [56]

Classification of anemia in children

The etiopathogenetic classification of anemia in children includes the following:

I. Anemia with an endogenous etiology:

• Benign constitutional.
• Congenital hemolytic anemia of newborns.
• Congenital familial hemolytic.
  • such as Minkowski-Schoffart.
  • Cooley's disease.
  • sickle-cell.
  • oval cell, macrocytic.
• Anemia of premature infants.
• Malignant.
• Aplastic anemia of Ehrlich.
• Chlorose.

II. Anemia with an exogenous etiology:

• Posthemorrhagic.
• Almentary.
• Infectious and postinfectious.
• Toxic.
  • parasitic intoxication.
  • chronic and acute.
  • malignant formations.
  • related to non-compliance with hygiene standards.

[57], [58], [59], [60],

How to treat anemia in children?

To correctly determine how to treat anemia in children, it is necessary to know exactly the causes and mechanisms of its development. With a lack of iron, for example, it is necessary to take iron preparations in combination with a full and balanced diet. It is recommended to take such medications between meals or an hour before meals, drink the medicine with natural fruit juices, preferably with citrus fruits, if there is no allergic reaction. After the normalization of the amount of hemoglobin, treatment should be continued after completing the full course. Complex treatment includes full and proper nutrition, products with iron content (beef, cod liver, milk, buckwheat, eggs, chicken and rabbit meat, semolina, beef kidneys, walnuts, etc.). Herbal treatment is prescribed for disorders in the digestive system and impaired absorption of nutrients. To normalize the intestinal microflora and to remove inflammatory processes, mint and chamomile broths, as well as decoctions of dog rose, sage, oak cortex, St. John's wort are shown for use. The complex treatment also includes preparations containing vitamins and minerals. When there is a lack of iron, the drug hemoferon is used. Hemoferon taken inside for half an hour before eating. Calculation of dosage is made based on body weight: three to six milligrams of hemic iron per kilogram of body weight. Approximate dosage for children under the age of three months is 2.5 ml, from 4 to 9 months - 5 ml, from 10 months to 1 year - 7.5 ml, from 1 to 3 years - about 10 ml, from four to 6 years - 12.5 ml, from seven to ten years - 15 ml.

Treatment of iron deficiency anemia in children

Treatment for iron deficiency anemia is primarily aimed at eliminating the cause of the disease and replenishing iron stores in the body with iron-containing drugs. The main principles in the treatment of iron deficiency conditions in children are the following:

• Reimbursement of iron deficiency with drugs and medical diet.
• Continuation of treatment after normalization of hemoglobin level.
• Carrying out in cases of emergency blood transfusion, only if there is a threat to life.

Preparations used in ferrotherapy are divided into ionic (salt and polysaccharide iron compounds) and non-ionic (included in the hydroxide-polymaltose complex of 3-valent iron). Daily daily dose of iron-containing drug is calculated taking into account the age indices of the child. The recommended daily dose of saline preparations containing iron in the treatment of iron deficiency for children under three years is 3 mg / kg body weight; for children from the age of three years - 45-60 mg of elemental iron per day; for adolescents - up to 120 mg / day. When using the preparations of the 3-valent iron hydroxide-polymaltose complex, the daily dosage for infants is 3-5 mg / kg body weight. The positive effect with the reception of iron preparations is manifested gradually. After normalization of the hemoglobin level, there is an improvement in the condition of the muscles, two weeks after the start of treatment, an increase in the level of reticulocytes is noted. The disappearance of the clinical symptoms of anemia is usually observed one to three months after the initiation of therapy, and the complete replacement of iron deficiency in three to six months from the start of treatment. The daily dose of iron-containing drug after increasing the hemoglobin level is half the therapeutic dose. With unfinished treatment, the likelihood of recurrence of the disease is high. For intramuscular injection of iron, the drug ferrum lek is used. The maximum daily dose for intramuscular injections for children weighing up to five kilograms is 0.5 ml, with a weight of five to ten kilograms - 1 ml. The approximate duration of treatment with mild anemia is two months, with an average severity of two and a half months, with severe anemia - three months.

Nutrition for anemia in children

Proper and adequate nutrition with anemia in children is very important. In the first months after birth, the child should receive the necessary amount of iron with the mother's milk. With the further introduction of complementary foods (about the age of six to seven months), breast milk improves the absorption of iron from other foods. Particularly in need of control of iron consumption, children who have a low weight, often who are ill are born much earlier than expected time. Starting from eight months, the meat should be included in the baby's diet, which is a full-fledged source of iron, buckwheat and barley porridge. Beginning with a one-year-old age, in the diet, in addition to meat, there must be fish. The joint use of meat and fish products in combination with vegetables and fruits improves the assimilation of iron from them. Vitamin C supplementation also improves the absorption of iron. Nutrition for anemia in children can include dishes and foods from diet table 11. Diet № 11 includes products with a high content of calories, the required amount of proteins, fats and carbohydrates, vitamins, minerals. The recommended diet is five times a day. The dietary table №11, recommended for feeding children with anemia, includes the following dishes and products: bread, flour products, soups, meat, fish, liver, cottage cheese, cheese, butter, eggs, buckwheat, oatmeal, pasta, pea or bean puree, berries, vegetables, fruits, natural honey bees, broth of wild rose.

Prevention of anemia in children

Prevention of anemia in children is carried out with the help of laboratory blood tests in order to timely detect and prevent the further development of mild forms of anemia. The district pediatrician, on the basis of a general examination and laboratory data, prescribes the necessary preventive measures. The risk group is children with a hereditary predisposition to the disease, if the mother during pregnancy had iron deficiency in the body, late toxicosis, swelling or other factors that depress the process of hematopoiesis in the fetus. Also at risk are children with insufficient birth weight; children staying on artificial feeding and not receiving enough nutrients; children born with premature pregnancy. Children who were born with premature pregnancy, for preventive purposes, are prescribed iron preparations from the third month after birth and up to two years. Prevention of anemia in children is also a full and balanced diet, containing the necessary amount of proteins, vitamins and minerals. The child should eat meat, liver, eggs, fish, cheese, cottage cheese, vegetables and fruits, natural juices. For the general strengthening of the body, it is necessary to lead a healthy lifestyle, walk in the fresh air, exercise and become tempered.