Could my baby be developing anaemia?

Dear Dr Ombeva,

My son has been on iron treatment with Hemoforte daily syrup for four months now. The doctor said he needs it because he was born before the due date, and may get anaemia. How do I know if he has the anaemia or not, and what to do if it occurs? Thanks.

Answer

Anaemia refers to low blood iron (haemoglobin) level. The symptoms are often subtle and may look like other illnesses, such as infection or respiratory distress. Depending on the severity, babies who are anaemic may be pale in colour, with a rapid heart rate, rapid breathing rate, poor weight gain, feeling tired constantly, dizziness, and sometimes nausea.

There are some hereditary diseases which can cause anemia, and these may be mild or severe depending upon the severity of the genetic disorder. Most newborn babies have some degree of mild anaemia. Babies are usually at their most anaemic around 2 to 3 months old, and gradually improve over the next two years. This anemia usually doesn’t need any treatment.

In the last weeks of pregnancy, a lot of the iron needed to make new red blood cells is transferred from the mother to baby. Besides, red blood cell production switches from the liver to the bone marrow. Because the processes that make new red blood cells are immature in preterm babies, they have a higher rate of anaemia and their anaemia is more severe than in term babies.

This is the category I think in which your child falls, and these often require iron syrup replacement up to at least six months of age. If your baby shows any of the above symptoms of anemia, doctors may do a blood test to check the hemoglobin (Hb) level.

In general, to correct anemia, a child’s body needs to produce new red blood cells to replace those that were lost. It takes about 5-7 days to start developing red blood cells which should increase hemoglobin levels within 2-3 weeks of starting iron supplementation. A child may need to continue to take an iron supplement for several months in order to build up iron store in the body and prevent anemia from returning.

To avoid iron deficiency anemia, a child’s diet should be iron-rich foods such as: red meat; fish; chicken; liver; eggs; dried fruits, like apricots, prunes, and raisins; lentils and beans; green, leafy vegetables, like spinach and broccoli. Also feed the child on foods that help the body absorb iron, like orange juice, strawberries, broccoli, or other fruits and vegetables with vitamin C.

Avoid giving the child coffee or tea with meals. These drinks make it harder for the child’s body to absorb iron. Make sure the child gets enough folic acid and vitamin B-12 in his diet.

Dr Ombeva Malande is a paediatrics and child health expert