Chapter 32: Iron-Deficiency Anemia (Children)

Question 1

Iron-Deficiency Anemia

Answer 1

microcytic (small), hypochromic (paler in color) anemia caused by an inadequate supply of iron

• common in infants
• premature infants at high risk b/c of their decreased fetal iron supply

Question 2

Iron

Answer 2

essential for the production of hemoglobin
-when inadequate, the production of hemoglobin is diminished; as a result there is a decreased oxygen0-carrying capacity of the blood

Question 3

Factors Associated with the Development of Iron-deficiency Anemia in Infants and Children

Answer 3

• stop breastfeeding too early
• giving formula that is non-iron-fortified
• prolonging bottle-feeding
• drinking more than 2 cup of cow’s milk a day (children 12 months and older)

Question 4

Common Causes of Iron-Deficiency Anemia

Answer 4

> Decreased Iron Supply

• inadequate iron supply at birth
• nutrition: deficient iron intake, excessive milk, limited solid foods, poor eating habits, vegetarian diet, increased fast foods

> Increased Iron Demands:
-Growth: low birth weight; twins or multiple births, prematurity/infants; adolescence; pregnancy; cyanotic congenital heart diseases (e.g. tetralogy of Fallot)

> Blood Loss:
-acute, chronic, parasite infection, GI tract (the most common site)

> Inability to Form Hemoglobin
-lack of vitamin b12 (e.g. pernicious anemia); folic acid deficiency

> Impaired Absorption

• presence of iron inhibitors: phytates, phosphates, or oxalates; gastric alkalinity
• malabsorption syndrome (e.g. celiac disease, severe prolonged diarrhea, post-gastrectomy, inflammatory bowel disease)

Question 5

Signs and Symptoms

Answer 5

vary with severity of disorder
-if has mild, may be asymptomatic
-the deficiency may not be apparent until lab tests are performed (decreased hemoglobin/hematocrit)
>with moderate to severe iron-deficiency anemia:
-irritability
-fatigue
-delayed motor development
-tachycardia
-SOB
-decreased activity level
-pale skin
-conjunctival pallor
-listlessness
-systolic heart murmur
-hepatomegaly (enlarged liver)

Question 6

Pica

Answer 6

the eating of non-nutritive value such as starch, clay, ice, or paper

• may be associated with iron-deficiency anemia
• iron deficiency, alone or with anemia, may result in impairment of cognitive skills that may not be reversible

Question 7

Diagnosis

Answer 7

based on patient history and physical examination findings

-laboratory tests= those that quantify or describe hemoglobin, iron concentration, and morphological changes in RBC

Question 8

Nursing Care

Answer 8

• prevention is key to avoiding iron-deficiency anemia
• ensure children eat iron-rich foods such as beans, meat, fortified cereals, eggs, and green leafy vegetables
• if oral iron supplements prescribed, parents are taught how to properly administer them to child

Question 9

Iron Rich Foods to Give to Children

Answer 9

• beans
• meat (red)
• whole grains
• nuts
• fortified cereals
• eggs
• green leafy vegetables

Question 10

Medical Care

Answer 10

early identification and recognition is essential
-this anemia can be avoided with appropriate food selections
-dietician provides nutritional counseling and assists with obtaining recommended iron-fortified formula and cereal
-oral iron supplements may be prescribed if dietary treatments are not successful (3 mg/kg per day based on body weight in 1 to 2 divided doses)
-severity of anemia dictates the monitoring and frequency of laboratory testing and follow-up
-several days after initiating iron replacement therapy, the reticulocyte count will rise, which is an indicator of RBC production
>children who are compliant with oral iron replacement therapy usually have a clinical response within 1 to 2 weeks; importance of compliance with iron administration and of follow-up visits to monitor hemoglobin, hematocrit, and reticulocyte count

Question 11

Preventing Iron-Deficiency Anemia: What to tell Parents

Answer 11

• feed your infant breast milk or commercial infant formula recommended for the first 12 months of life
• “are you aware of community resources such as WIC to provide assistance with formula and iron-fortified foods?”
• be sure to use iron-fortified cereal from 6 to 12 months of age
• do not feed your infant cow’s milk before 12 months of age b/c it does not contain iron and essential nutrients. After 12 months, limit the amount of cow’s milk to 18 to 24 ounces per day
• offering solids before giving the bottle helps prevent iron deficiency
• tell adolescents on a vegetarian diet or weight reduction diet to understand proper dietary alternatives. Red meats, beans, whole grains, nuts, and iron-fortified cereals are good sources of iron

Question 12

Education about Oral Iron Intake/Administration

Answer 12

• take between meals b/c absorption is improved in an acidic environment
• administer with a glass of orange juice may enhance absorption
• NOT taken with tea or dairy products b/c they may adversely affect the absorption process
• liquid iron preparations may stain teeth; administer with a dropper or drink through a straw; rinse mouth out after taking liquid medication
• iron can be constipating; increase fiber and water intake
• possible side effects: gastric upset, nausea, vomiting, and constipation; black, tarry stools are common and normal for children taking iron supplements
• keep out of reach of small children, ingestion of excessive quantities can be toxic and fatal

Question 13

An overweight Child diagnosed with iron-deficiency anemia

Answer 13

-while most infants are underweight with this disease, overweight may also have this disorder
-are overweight b/c of excessive milk ingestion, known as “milk baby”
-infants are chunky, pale, and have a “porcelain-like” appearance
-have poor muscle development and are susceptible to infections
>obtain a nutritional hx from parents