Anemia in Children

What is anemia in children?

Anemia is a common problem in children. About 20% of children in the U.S. will be diagnosed with anemia at some point. A child who has anemia doesn't have enough red blood cells or hemoglobin. Hemoglobin is a type of protein that allows red blood cells to carry oxygen to other cells in the body.

There are many types of anemia. Your child may have one of these:

• Iron deficiency anemia. This is when the child doesn't have enough iron in the blood. Iron is needed to form hemoglobin. This is the most common cause of anemia. 

• Megaloblastic anemia. This is when red blood cells are too large from a lack of folic acid or vitamin B-12. One type of megaloblastic anemia is pernicious anemia. In this type, there is a problem absorbing vitamin B-12, important to making red blood cells.

• Hemolytic anemia. This is when red blood cells are destroyed. There are many different causes, such as serious infections or certain medicines.

• Sickle cell anemia. This is a type of hemoglobinopathy, an inherited type of anemia with abnormally shaped red blood cells.

• Cooley's anemia (thalassemia).  This is another inherited type of anemia with abnormal red blood cells.

• Aplastic anemia. This is failure of the bone marrow to make blood cells.

What causes anemia in a child?

Anemia has three main causes:

• Loss of red blood cells

• Inability to make enough red blood cells

• Destruction of red blood cells

Decreased red blood cells or hemoglobin levels may be due to:

• Inherited red blood cell defects

• Infections

• Some diseases

• Certain medicines

• Lack of some vitamins or minerals in the diet

Which children are at risk for anemia?

Risk factors for anemia include:

• Premature or low birth weight

• Living in poverty or immigrating from developing country

• Too much cow’s milk

• Diet low in iron, or some vitamins or minerals

• Surgery or accident with blood loss

• Long-term illnesses, such as infections, or kidney or liver disease

• Family history of an inherited type of anemia, such as sickle cell anemia

What are the symptoms of anemia in a child?

Most symptoms of anemia are due to the lack of oxygen in the cells. Many of the symptoms don't occur with mild anemia.

These are the most common symptoms:

• Increased heart rate

• Breathlessness, or trouble catching a breath

• Lack of energy, or tiring easily

• Dizziness, or vertigo, especially when standing

• Headache

• Irritability

• Irregular menstrual cycles

• Absent or delayed menstruation

• Sore or swollen tongue

• Pale skin

• Yellowing of skin, eyes, and mouth (jaundice)

• Enlarged spleen or liver

• Slow or delayed growth and development

• Poor wound and tissue healing

Many of these symptoms may be caused by other blood problems or health conditions. Anemia is often a symptom of another disease. Report any symptoms to your child’s healthcare provider. Always see your child's provider for a diagnosis.

How is anemia diagnosed in a child?

Because anemia is common in children, healthcare providers do routine screening for it. Plus, it often has no symptoms. Most anemia in children is diagnosed with these blood tests:

• Hemoglobin and hematocrit.  This is often the first screening test for anemia in children. It measures the amount of hemoglobin and red blood cells in the blood.

• Complete blood count). A complete blood count checks the red and white blood cells, blood-clotting cells (platelets), and sometimes young red blood cells (reticulocytes). It includes hemoglobin and hematocrit and more details about the red blood cells.

• Peripheral smear. A small sample of blood is checked under a microscope to see if the blood cells look normal.

To get a blood sample, a healthcare provider will insert a needle into a vein, often in the child's arm or hand. A tourniquet may be wrapped around the child's arm to help the healthcare provider find a vein. Blood is drawn up into a syringe or a test tube. In some cases, blood can be taken using a needle prick.

Blood tests may cause a little discomfort while the needle is inserted. It may cause some bruising or swelling. After the blood is removed, the healthcare provider will remove the tourniquet, put pressure on the area, and put on a bandage.

Depending on the blood test results, your child may also have a bone marrow aspiration, biopsy, or both. This is done by taking a small amount of bone marrow fluid (aspiration) or solid bone marrow tissue (core biopsy). The fluid or tissue is checked for the number, size, and maturity of blood cells or abnormal cells. 

How is anemia in a child treated?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how bad the condition is.

The treatment for anemia depends on the cause. Some types don't need treatment. Other types may need medicine, blood transfusions, surgery, or stem cell transplants. Your child's healthcare provider may refer you to a hematologist. This is a specialist in treating blood disorders. Treatment may include:

• Vitamin and mineral drops or pills

• Changing your child's diet

• Stopping a medicine that causes anemia

• Blood transfusions

• Stem cell transplants

• Surgery to remove the spleen (very rare)

What are possible complications of anemia in a child?

The complications of anemia depend on what is causing it. Some types have few complications. But others have frequent and serious complications. Some anemias may cause:

• Problems with growth and development

• Joint pain and swelling

• Bone marrow failure

• Leukemia or other cancers

What can I do to prevent anemia in my child?

Some types of anemia are inherited and can’t be prevented. Iron deficiency anemia, a common form of anemia, may be prevented by making sure your child gets enough iron in their diet. To do this:

• Breastfeed your baby if possible. They will get enough iron from your breastmilk until about 4 months of age. At 4 months, add an iron supplement.

• Give formula with iron. If your child is on formula, use formula with added iron.

• Don't give cow’s milk until after age 1. Cow’s milk doesn't have enough iron. It should not be given to babies until after they are 1 year old, when they are eating enough other food. Too much cow's milk also prevents the body from absorbing iron. Iron is needed to make new red blood cells.

• Feed your child iron-rich foods. When your child eats solid foods, choose foods that are good sources of iron. These include iron-enriched grains and cereals, egg yolks, red meats, potatoes, tomatoes, and raisins.

When should I call my child's healthcare provider?

Call your child's healthcare provider if you notice that your child has any of the symptoms of anemia. And if your child hasn't been checked for anemia, talk with the provider about your child's risk of getting it.

Key points about anemia in children

• Anemia is a low red blood cell count or a low hemoglobin level. It's a common problem in children.

• There are many different types of anemia. 

• Risk factors for children include being premature, living in poverty, having too much cow's milk, a diet low in iron, and certain long-term illnesses.

• Mild cases often have no symptoms. But common symptoms include fast heart rate, breathlessness, lack of energy, dizziness, headache, and irritability.

• The treatment of anemia depends on what is causing it.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s healthcare provider after office hours, and on weekends and holidays. This is important if your child becomes ill and you have questions or need advice.