Anaemia in Babies

Anaemia in babies occurs due to the shortage of red blood cells in the body. These cells carry oxygen from the lungs to the tissues in the body, so their shortage can lead to a range of symptoms such as weakness, pale skin, rapid heartbeat, etc. Anaemia can be prevented with proper supplementation of iron in the food.

What Is Anaemia in Infants?

The signs of anaemia in babies are tiredness, pale skin, loss of appetite, irritability, brittle nails, sore or swollen tongue, and rapid heartbeat. It is due to the lack of red blood cells that oxygen is not transported to all the tissues in the body. The most common cause of anaemia in babies is the deficiency of iron which is vital for making red blood cells that carry oxygen. Long-term effects of anaemia in infants include a delay in reaching developmental milestones.

Let’s look at some causes of anaemia in babies.

Possible Causes of Anaemia in Babies

Some causes of anaemia in infants include:

1. Sickle Cell Disease: Sickle cell disease is a genetic disorder that destructs red blood cells (RBCs) in the bloodstream. RBCs transport oxygen to all the tissues in the body, and the disorder makes the body’s immune system attack the healthy RBC. Also called hemolytic anaemia, the excessive loss of RBCs is higher than the replenished cells, which lead to anaemia.
2. Loss of blood: Blood loss resulting from internal bleeding or a wound due to an injury leads to the loss of RBCs. Other factors that contribute to it include frequent nose bleeding, bloody diarrhoea and inflammatory bowel disease.
3. Low production of RBCs: When RBCs are not being produced enough by the bone marrow, it is called aplastic anaemia. This can be due to bacterial or viral infections, side effects of medications, or certain forms of cancers involving the blood or the bone.
4. Nutritional Anaemia: Nutritional anaemia is when the child has a deficiency of iron, Vitamin B12, and folate. Iron deficiency is the most common cause of nutritional anaemia.

What Is Iron Deficiency Anaemia in Babies?

Anaemia can be classified as a disorder that is caused by the deficiency of Iron as a dietary nutrient. The red blood cells contain haemoglobin, an iron-containing protein that carries oxygen to the different parts of the body. If your baby doesn’t get enough iron in food, they’ll have fewer red blood cells, leading to iron deficiency anaemia. Kids are especially susceptible to anaemia during their growth spurts. However, it should be noted that iron-deficiency anaemia doesn’t occur overnight. It is caused by a prolonged deficiency of iron. Also, deficiencies can occur due to reasons such as lesser amounts of iron in the food or blood loss in the intestinal tract.

What Causes Low Iron in Infants?

The deficiency of iron in infants is caused by many reasons, such as:

1. Insufficient Dietary Intake of Iron: Babies have enough reserves of iron in their bodies, and they get plenty of it from the breast milk to last until 6 months. Beyond that, they should be given plenty of iron-rich foods to meet their growing needs. All babies between the ages of 9 and 24 months are at risk of anaemia, and hence those who are fussy eaters and don’t eat enough iron-rich foods might develop anaemia.

2. Premature Birth: Full-term babies are born with iron reserves in their bodies which can last them 4 to 6 months. However, premature babies may have reserves that could last only for about two months or so; hence they are at a higher risk of developing anaemia. It is seen that about 85% of premature babies below a weight of 1.5 kg can develop anaemia.

3. Diabetic Mothers: Babies who are born to diabetic mothers who did not take care of it properly are at a greater risk of developing anaemia (1).

4. Low Birth Weight: The haemoglobin levels of a mother are responsible for low birth weight (2) and anaemia in babies, especially if the mother had been anaemic during the third trimester (3).

5. Introducing Cow’s Milk Before the Baby Turns 12 Months Old:  Babies who are introduced to cow’s milk before they are 12 months old are at risk of developing anaemia. Cow milk has low iron content, and it also interferes with the body’s absorption of iron. Cow’s milk can also irritate the intestine’s lining and cause bleeding.

What Are the Symptoms of Iron Deficiency in Babies?

Here are some of the signs of anaemia in babies (4):

1. Pale Skin: When a baby is anaemic, his skin loses its colour and texture and appears pale and dull. It is predominantly noticeable around the eyelids and hands.

2. Lethargy: Anaemic babies may also have low energy and show acute drowsiness most of the time.

3. Weakness: A baby with anaemia is tired all the time and shows a lack of interest in activities.

4. Low Appetite and No Interest in Food: If your baby has anaemia, he will eat very less or not eat at all.

5. Irritability: Babies may be constantly irritated for unknown reasons, and the older ones may also show tantrums.

6. Difficulty in Breathing: Anaemic babies may have trouble breathing as they tire themselves out, trying to get as much oxygen as possible. They also suffer from shortness of breath frequently.

7. Faster Heart Rate: In anaemic babies, the heart tries to pump more blood and hence beats faster with irregular beating patterns.

8. Swelling in the Limbs: Some babies might have swelling in the limbs, hands, and feet.

9. Pica: Pica is a condition characterised by infants craving for non-food items such as mud, chalk, metal, etc. This is an important indicator of a nutrient deficiency of some sort.

10. Lowered Growth Rate: Since the body doesn’t get sufficient oxygen for its metabolic processes, babies show poor growth in terms of head circumference, height, and weight for their age.

Sometimes, just the symptoms are not enough to conclude a baby is anaemic. A proper diagnosis is needed to confirm the condition and provide proper treatment. Read on to learn how anaemia can be diagnosed and treated in babies.

How to Diagnose Iron Deficiency Anaemia in Infants

There are certain tests that can be done to diagnose anaemia in babies:

1. RBC Test: A drop of your baby’s blood is observed under a microscope to confirm the count or size of the RBCs. Usually, a low count or small size of the RBCs hints at anaemia. Counting is also done to estimate the number of new and old RBCs; to determine if their production is normal. The percentage of blood plasma is also determined by a hematocrit test (5). A small stool sample may also be tested to look for loss of RBC through internal bleeding.

2. Iron Test: A baby’s blood sample is tested for haemoglobin and iron levels. Ferritin, a protein that stores iron, will also be tested (6). Screening for a genetic disease such as sickle cell may also be done.

How Can Iron Deficiency Anaemia Be Treated?

The treatment for anaemia in babies involves replenishing the lost iron in the baby’s body. It is done in the following ways:

1. Iron supplements: Iron supplements in the form of powder or syrups are given to boost iron intake. The supplements also contain vitamin C as it aids in the absorption of iron.

2. Iron-rich food supplements: The baby’s paediatric dietician would recommend a diet plan that is rich in iron to replenish the baby’s low iron reserves.

Does Iron Deficiency Anaemia Have a Long-Term Effect On Your Anaemic Baby?

Anaemia in babies results in a delay in meeting the developmental milestones, as their growth rate is slower. Anaemia also compromises the baby’s immunity and makes him prone to infections. In severe cases, it can lead to physical and mental retardation. A deficiency of iron leads to regressions in the skeletal muscles and functions of the brain, which results in lower IQ. Babies may also have behavioural issues and problems in socialising.

Are There Any Preventive Measures?

There are certain measures that you can try to prevent anaemia in babies; they are as follows:

• If the baby is born preterm or has a low birth weight, discuss with your doctor about iron supplements and come up with a long-term treatment course.

• Do not feed cow’s milk to your baby until he is about a year old. Breast milk and iron-fortified formula milk should suffice.

• The usual dose of iron for preventing iron deficiency anaemia is 2 mg/kg per day, to be started between 4 to 6 months of age. Considering the average Indian baby weighs 2.5 kg at birth and 5 kg by 5 months, the dose would be approx 10 to 11 mg per day. This is a good way to avoid anaemia in breastfed babies.

• Once the baby starts on solid foods, they should be given iron-fortified cereal and, eventually, iron-rich foods. Poultry, lean meats, fish, green leafy vegetables, egg yolks, legumes and iron-fortified rice, and bread are ideal foods to start with.

• Vitamin C-rich foods such as citrus fruits, avocados, kiwi, and cantaloupe should also be added to the diet.

With adequate supplementation of iron in food, anaemia can be avoided in babies. Therefore, equal attention must be paid to breastfeeding and the introduction of healthy foods once the baby is six months old.

References:

1. Rao, R., & Georgieff, M. K.: Iron in fetal and neonatal nutrition: PubMed Central (PMC), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2048487/, December 2006

2. Muhammad Owais Ahmad et al: Effect of maternal anaemia on birth weight: PubMed, https://pubmed.ncbi.nlm.nih.gov/22830153/#:~:text=Maternal%20anaemia%20is%20commonly%20considered,not%20found%20a%20significant%20association., March 2011

3. K Jagadish Kumar et al.: Maternal Anemia in Various Trimesters and its Effect on Newborn Weight and Maturity: An Observational Study: PubMed Central (PMC),  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604852/#:~:text=Results%3A,This%20difference%20was%20statistically%20significant., February 2013

4. Anemia Caused by Low Iron – Infants and Toddlers: MedlinePlus Medical Encyclopedia, https://medlineplus.gov/ency/article/007618.htm#:~:text=Babies%20are%20born%20with%20iron,it%20is%20in%20breast%20milk

5.  Hematocrit: MedlinePlus Medical Encyclopedia, https://medlineplus.gov/ency/article/003646.htm

6. Ferritin Blood Test: MedlinePlus Medical Encyclopedia, https://medlineplus.gov/ency/article/003490.htm

Also Read: Leukaemia in Children