Understanding Haemoglobin Deficiency in Children: Prevention and Care

Haemoglobin is a crucial component of red blood cells, made up of a protein called globin and a compound called heme. Heme includes iron and a pigment called porphyrin, which gives blood its distinctive red colour. This critical molecule plays an essential role in transporting oxygen and carbon dioxide throughout the body. Hemoglobin deficiency leads to anemia, a major public health problem and a more prevalent condition in children and young menstruating girls. This blog explores the causes, treatment and preventive strategies for haemoglobin deficiency.  

Understanding haemoglobin deficiency

Haemoglobin deficiency means the body is not getting adequate oxygen supply, resulting in many symptoms. In children aged between 6–12 years, haemoglobin deficiency is diagnosed when the haemoglobin level falls below 11.2 g/dL.  

Young infants around 6 to 9 weeks old are commonly affected by physiologic anaemia, which happens due to decreased erythropoiesis after birth. In this case, haemoglobin levels are initially high at birth (>14 g/dL) and drop to about 10–11 g/dL.  

Iron deficiency anaemia is more common in older children and adolescents. Screening is recommended at 9–12 months, especially for those exclusively breastfed without iron supplements or those transitioning from iron-fortified formula to cow’s milk. Additional screening is advised for children with risk factors like excessive cow milk intake or adolescent girls who have started menstruating.

Causes  

The causes of low haemoglobin in children include:

• Insufficient nutrients such as iron and vitamins B12 and B9
• Inherited diseases (like thalassemia and sickle cell anaemia)  
• Certain medications
• Infections such as malaria
• Autoimmune conditions

Symptoms

When haemoglobin levels are low, the body struggles to deliver enough oxygen to tissues, leading to various symptoms. Here are some of them:

• Pale skin  
• Shortness of breath
• Persistent tiredness and lack of energy
• Difficulty in performing physical activities
• Lack of appetite  
• Neurocognitive and behavioural issues in young children, especially if iron deficiency is present.

Understanding these symptoms is crucial to early detection and management of low haemoglobin levels, ensuring timely intervention and care.  

How is haemoglobin deficiency diagnosed?

The common tests to diagnose haemoglobin deficiency include:

• Haemoglobin and haematocrit: This happen to be the primary screening test that measures the amount of red blood cells in the blood.
• Complete blood count (CBC). This involves a comprehensive evaluation of all blood cells, such as red and white blood cells, blood clotting cells (platelets) and, sometimes, young red blood cells (reticulocytes).  
• Peripheral smear. This test involves thinly spreading a drop of blood on the microscopic slide to check the presence of shape, size, and number of blood cells. Peripheral smear test is commonly used to diagnose blood disorders and asses the appearance of blood cells.
• Iron studies: They help diagnose any condition related to iron overload or deficiency.

Treatment and prevention of haemoglobin deficiency in children

Prevention

Preventing haemoglobin deficiency in children involves ensuring they receive adequate iron from their diet and supplements when necessary. Here are key recommendations:

Infants (0–12 months)  

• Breastfed infants: Starting at 4 months, exclusively or partially breastfed infants should receive a daily iron supplement until they begin eating iron-rich foods.
• Formula-fed infants: Iron supplements are not needed as the formula contains added iron. Avoid giving whole milk to infants under 12 months.

Toddlers (1–3 years)

• Ensure a diet rich in iron, including iron-fortified cereals, red meats and iron-rich vegetables.
• Include fruits high in vitamin C to enhance iron absorption.

Treatment

Treating haemoglobin deficiency focuses on increasing iron levels through supplements and dietary changes:

Iron supplements: Iron drops or pills taken over several months can significantly increase iron levels. These should be taken on an empty stomach or with orange juice to improve absorption. Iron supplements can irritate the stomach and lead to dark bowel movements

• Intravenous iron: For children who cannot tolerate oral supplements, IV iron may be necessary
• Iron-enriched foods: Include cereals and rice fortified with iron
• Meats: beef, liver, lamb and pork
• Poultry: Dark meat from chicken, duck and turkey, as well as liver
• Fish: Oysters, sardines, anchovies and mussels
• Leafy greens: Vegetables such as broccoli, kale, turnip greens and collards
• Legumes: Green peas, Lima beans, pinto beans, canned baked beans and black-eyed peas
• Whole-wheat bread: Yeast-leavened whole-wheat bread and rolls

By following these prevention and treatment strategies, you can help ensure your child maintains healthy haemoglobin levels and overall well-being.