Although iron deficiency and anemia due to iron deficiency are common in all age groups, it is more common in children, especially during two growth spurts, that is, in the 6-24 month old infancy period and during adolescence. Iron deficiency is observed in 30-40 percent of preschool children.
Unless the breastfeeding mother has a very severe iron deficiency, the iron resources available in the mother during the first 4-6 months are sufficient for our baby. However, as of the fourth month, when our baby enters the period of rapid growth, insufficient stores in the mother, a diet poor in iron, and use of cow's milk can be said to be the most common reasons why iron deficiency does not occur.
In addition to rapid growth during adolescence, that is, adolescence. ; Iron-poor diet and menstrual bleeding observed in our girls are the causes of iron deficiency.
Iron is a very important element for life. It is involved in protein synthesis, oxygen transport, electron transport, cell respiration, and the structure and function of many enzymes. In its deficiency, not only anemia but also disorders in the functions of other systems such as the nervous system occur.
When anemia occurs; Complaints such as fatigue, weakness, dizziness, headache, palpitations, getting tired easily, pale skin color, pain in the tongue, decreased sense of taste, broken and streaked nails, and wounds in the corners of the mouth may occur. There may be a desire to eat substances that are not used as food, such as soil, ice, salt, paper, lime, which is called PIKA syndrome. Due to the functions of iron outside of blood cells, irritability, loss of appetite, inability to concentrate in classes, decrease in school success, difficulty in understanding and perception, decrease in intelligence level, and frequent infections may develop. Infants may present with difficulty in swallowing, turning blue when crying (seizures), and a pause or regression in their development. A regression may be observed in the current motor and intelligence development of babies. These findings can be seen in the early stages of iron deficiency, before anemia even occurs.
When there is iron deficiency, first the iron stores in the liver decrease and we examine this in the laboratory. In blood tests, we observe a decrease in serum ferritin. Then, serum iron decreases, and iron binding capacity increases in order to use more of the existing decreased iron. We observe a decrease in the transferrin saturation value, which is another laboratory test, but anemia has not yet developed. In the last period, iron deficiency becomes severe, anemia is now present and related symptoms appear. In iron deficiency anemia, erythrocyte count, hemoglobin, and hematocrit values are low; mean erythrocyte volume, mean erythrocyte hemoglobin, mean erythrocyte hemoglobin concentration decreased. Erythrocyte distribution width increased.
In the treatment, iron-containing medications are given in the form of drops or syrup to be taken orally. Medicines are usually given twice a day, preferably between meals, when the child is hungry. For breastfed children, it is given two hours after breastfeeding or half an hour before breastfeeding. It should not be given with milk and milk-containing foods, at least half an hour must pass. Beverages and foods containing vitamin C increase iron absorption. Therefore, children who have difficulty in taking iron medication may try giving it with orange or kiwi juice. It is very important to use iron medications regularly and for a sufficient period of time. Together, the family and the patient are informed about a balanced and iron-rich diet.
Treatment duration is approximately three months. After the first month of treatment, it is necessary to see that the hemoglobin value reaches normal limits. If the hemoglobin value reaches the normal value, the dose of iron medication is reduced and treatment is continued for another 6-8 weeks. Thus, iron stores are also filled. The child should be re-evaluated three months after iron therapy is discontinued; If anemia still occurs, there is an underlying cause and this must be revealed.
Because the taste of iron-containing drugs is not very sweet, some children may be resistant to taking the drug. In these children, giving the medicine with orange juice is beneficial in terms of increasing both taste and absorption.
Some children may experience constipation or diarrhea, abdominal pain and burning sensation in the stomach along with the use of the medicine. A feeling may develop. If there is abdominal pain, the medicine can be given in the evening while fasting. Stomach burning can be controlled by taking the medicine on a full stomach, at least half an hour after a meal. During the use of the drug, it may be observed that the color of the child's stool darkens close to black.
In order to prevent iron deficiency, it is important to start infants with low doses of protective iron medication at the end of the fourth month if they are born on time, or at the end of the first month if they are born prematurely, and to give iron-rich supplementary foods when the time comes. The Ministry of Health supports the practice of preventive iron therapy. The development of iron deficiency anemia can be prevented by adding additional foods with high iron content, such as red meat and eggs, to children's diet after the sixth month.
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