Anaemia: The Pale Child
|   Jan 31, 2017
Anaemia: The Pale Child

Anaemia simply means thin blood. Total Red Blood Cell (TRBC) count and Haemoglobin percentage is low in this condition. It is a rampant problem not only in lower socio-economic strata, but also in children from well-to- do families.

At birth the newborn baby has a relatively high hemoglobin level ranging between 15-17 g/dl. This gradually falls and the mean hemoglobin between 6 months and 6 years is 12 g/dl, with a normal range of 11-14. Between 7 and 12 years the average hemoglobin is 13 g/dl, with a normal range of 12 to 16.

Iron-Deficiency Anaemia

Anaemia can result from a variety of causes, but iron deficiency remains the commonest cause in our country. The main symptoms are:

  • Irritability
  • Poor appetite
  • Easy fatigability
  • Inattentiveness
  • Poor academic performance
  • Recurrent infections
  • Pica: eating of inedible objects e.g. mud, wall scrapings, sand, chalk, paper etc.

An anemic child is a pale child. The skin, conjunctiva, tongue and nails of these children are pale. To an untrained eye these changes would be apparent only when the hemoglobin levels have fallen well below the normal. Simultaneously it must also be remembered that a fair child who mostly remains indoors may have pale-looking skin and must not be confused with an anemic child.

Average life span of Red Blood Cells is 120 days. So, going by this argument the blood that the child received from his/her mother at birth is all but finished at about four months of age.

Moreover, the child has to manufacture his/her own blood and for that iron is required.

According to new recommendations weaning (introduction of solids and semisolids), which was previously done at 4 months, is not to be done before 6 months of age. Breast milk remains the only source of iron to the child, and if the mother herself is deficient in iron i.e. anemic, the plight of the child needs no elaboration.

We think after reading the previous two paragraphs, parents can well understand why children start developing anemia by 6 months of age and a substantial number of them, between 9 to 24 month of age, are anemic. Children given animal milk are likely to develop anemia at an even earlier age, because bovine milk is a poor source of iron. That is why any Paediatrician worth his salt, will always prescribe an iron salt (tonic) to your child around 4 months of age. However, babies born prematurely should be given iron from 6 weeks onwards.


Giving iron rich weaning foods can prevent iron deficiency anemia. Green leafy vegetables (Spinach, Fenugreek etc), fruits, tomatoes, red beans, unpeeled potatoes, raisins, ragi are good source of iron. Meat, liver, egg and fish are also rich in iron.

Although most doctors can diagnose anemia clinically, getting a Complete Blood Count and Haemoglobin level done helps in pinpointing the severity of anemia. The red blood cells in iron deficiency anemia are hypochromic (pale looking) and microcytic (smaller in size).

Hemoglobin level                             Grade of anemia                              Treatment

11-15g/dl                                                         Mild                                              Iron rich diet

5-10g/dl                                                       Moderate                                   Oral iron supplementation

                                                                                                                            and Iron rich diet

Less than 5g/dl                                             Severe                                     Blood transfusion Injectable  


Points to remember:

  • The total daily dose of iron should be divided into 2 parts and given in between meals, because milk and cereals interfere with the absorption of iron.
  • Vitamin C helps in the absorption of iron, so give the child a citrus fruit or fruit juice immediately after medication.
  • The iron tonic must be given far at least 90 days. This normalizes the hemoglobin level as well as replenishes the iron stores of the bone marrow.
  • After completion of the therapy, hemoglobin level should always be checked.
  • Temporary, greyish-black staining of teeth is generally seen during treatment. Giving a little water or brushing of teeth after each dose decreases the problem.
  • Bowel upsets – constipation or diarrhea are commonly seen is children being given iron.
  • The problem can generally be managed by reducing the dose, or changing the iron preparation.

Other Causes Of Anaemia:

Hookworm Anaemia: Hookworm infestation is seen in children playing bare foot on ground containing larvae of hookworms. The larvae enter the body of the child by penetrating the skin of the feet. They grow into adult hookworms, which attach themselves to the upper intestines by their hooks and suck blood.Children should be made to wear sandals on shoes when playing outdoors. Albendazole or Nitazoxanide can be used to eradicate hookworms from the intestines.

Thalassemia: It is a hereditary condition and is of two varieties: Major and Minor. In Thalassemia major there is a defect in the hemoglobin synthesis. The child suffers from severe anemia and requires repeated blood transfusions. Frequent blood transfusions deliver a huge load of iron to the body, which gets deposited in various organs including the liver and heart. This process is known as ‘Haemosiderosis’ and is ultimately responsible for early death.

Although drugs and electronic devices are now available to remove excess iron from the body, the average life expectancy is 25 years.

Thalassemia minor can be confused with iron deficiency anemia, because here also the RBCs are microcytic and hypochromic. This is a mild condition and does not harm the child. These children do not require any treatment.

G-6- PD Deficiency: In this condition, Red Blood Cells are deficient in G-6- PD enzyme. This makes them prone to excessive breakdown, causing anemia. About 5% of the Indian population (especially Sindhis, Parsis, Punjabis) is deficient in G-6- PD enzyme. A simple test available at most Pathology laboratories can detect this deficiency. Children suffering from G-6- PD deficiency should not be given following drugs because it can lead to a massive breakdown of RBCs:

  • Primaquine (malaria)
  • Sulpha drugs (antibiotic)
  • Nitrofurantoin (urinary infection)
  • Furazolidone (diarrhea)
  • Chloramphenicol (typhoid)
  • Paracetamol (fever)

There is a long list of conditions that can cause anemia e.g. excessive bleeding due to any cause, infections, blood group incompatibility, leukemia, certain drugs, folic acid and vitamin B12 deficiency, lead poisoning etc. Discussing all of them is beyond the scope of this book.

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