Anemia in Newborns, Babies and Children

Anaemia in newborns is caused by a number of different reasons. These causes could be prenatal, or they could develop during or right after delivery, or during postnatal childcare. The following are the chief causes behind anaemia in newborn babies.

• Most newborn babies have anaemia for the first few days after birth. This is natural, as it takes time for their tiny bodies to produce enough red blood cells on their own. This is known as physiologic anaemia, and usually goes away within a month or two.
• Babies who were born prematurely tend to have fewer red blood cells, and the life span of their RBCs is also low. This is known as anaemia of prematurity and needs to be treated.
• If a baby loses too much blood while in the neonatal intensive care unit (NICU) after premature labour and delivery or caesarean delivery, it can cause anaemia. Usually this type of anemia is dealt with by the NICU team, who treat it with timely blood transfusions.
• If the mother went through certain types of obstetrical complications, like placenta previa, placental abruption, etc., this can also cause postnatal anaemia in the baby as well as the mother.
• If the mother and baby’s blood types do not match, the baby’s body breaks down the red blood cells too quickly, which causes anaemia. This is known as Rh/ABO incompatibility, and in this case, anaemia can also be an inherited condition.
• Breast milk contains enough iron which can be easily absorbed for the production of RBCs. So newborns who are not breastfed for any reason have a higher chance of being anaemic soon after birth. (Read more: Benefits of breastfeeding)

Unfortunately, most newborns who have anaemia tend not to show any symptoms at all - which makes it difficult to diagnose their condition without frequent tests. However, the following symptoms are sometimes noted in newborns with anaemia.

• Pale skin
• Low energy or feeling sluggish
• Poor feeding or not feeding enough
• Getting tired during feeding
• Having a fast heart rate while resting
• Rapid breathing while resting

Even if your baby shows all the symptoms of being anaemic, the only way to confirm anaemia is through blood tests. These blood tests are done by the obstetrician or your primary healthcare provider, and they’re done frequently to measure any changes in the condition of the baby. The following markers in the baby’s blood help doctors figure out the condition better.

• Haemoglobin, the protein in RBCs that carries oxygen to the different parts of the body.
• Hematocrit, the percentage of RBCs in the blood by volume.
• Reticulocytes, the percentage of immature red blood cells in the blood, which helps determine the rate of RBC production in the body.

The correct treatment of anaemia for your baby will depend on the identification of the underlying condition that caused it in the first place. This course of treatment will, therefore, be decided by your doctor. It’s important to note that most newborn babies do not need any active treatment to cure anaemia, as it tends to fade away as the baby’s body learns to produce enough red blood cells by itself.

However, premature babies and those who are sick might need blood transfusions to increase the RBC count in the body. A lot of babies with anaemia are also given medications to help their body produce more RBCs. These medications are in drop form, which makes them easy to administer to babies.

The most important and natural way of treating anaemia is by monitoring the diet of the newborn by checking the feedings. The right diet helps in the production of RBCs, and so providing proper nutrition is the best way to deal with anaemia in newborns.

Anaemia is caused by low red blood cell count in the body, and the prevalence of this condition in a toddler or child usually has three main causes:

• Loss of red blood cells
• Inability to produce enough red blood cells
• Destruction of red blood cells

This decrease in or the low production of red blood cells can be caused due to any of the following underlying issues:

• Lack of iron, folate, vitamin B12 and other vitamins and minerals in the diet.
• Inherited anaemia or red blood cell defects, like sickle cell anaemia.
• Infections and other diseases.
• Certain types of antibiotics, penicillin and other medications.

Since the red blood cells carry oxygen to all the parts of the body, most of the symptoms of anaemia in children are related to lack of oxygen supply. If the anaemia in your child is mild, these symptoms might not even show up. However, in most cases, the following symptoms of anaemia might show in children:

• Lack of energy or getting tired easily
• Increased heart rate
• Breathlessness
• Dizziness when standing
• Headache
• Irritability
• Sore tongue
• Yellowing of skin, mouth, eyes
• Slow or delayed growth
• Poor wound and tissue healing

It’s important to remember that anaemia is often the symptom of an underlying disease. It’s therefore of the utmost importance to take your child to the doctor if any of the symptoms of anaemia in children show up. Usually, doctors themselves regularly screen children for anaemia because of its high prevalence in India. 

The best way to confirm anaemia, and figure out the underlying issue causing it, is by doing a blood test. In children, the blood test usually looks for the following markers:

• Haemoglobin and hematocrit count, just like in the case of newborns.
• A complete blood count (CBC), which reveals the condition of white blood cells, platelets and reticulocytes.
• Peripheral smear, or the study of a blood sample under the microscope to check if the blood cells look normal.

The treatment of anaemia in children usually depends on the severity of their symptoms and age. Most of this treatment is similar to the treatment given to newborns, but the nature of the treatment might be different. For example, children above six or seven years of age can swallow medicines which are in the form of pills and tablets, so you need not get drops if medications are recommended for them. 

Similarly, young children - unlike newborns - are not dependent on breast milk for their nutrition. So changes in their diet, especially the increased intake of foods rich in iron, folate and vitamin B12, can improve their condition significantly.

Primary caregivers can access many delicious healthy recipes with foods like banana milkshake: bananas are rich in vitamin B6 and vitamin C - vitamin C helps the body absorb iron. Milk is a source of vitamin B12. Foods like eggs, curd, milk, beans, spinach are all excellent sources of iron and essential vitamins. 

In severe cases, however, the treatment of anaemia in children can involve blood transfusion, stem cell transplants and even the removal of the spleen (splenectomy) if it is damaged. 

There are a number of risk factors that increase the chances of anaemia in children. Some of these risk factors might be out of your control, while others can be reduced with ease. Here are the most common risk factors of anemia in children:

• Poverty
• Living in a developing country
• Family history of anaemia
• Premature birth
• Low birth weight (under 2.5 kilograms at birth)
• Early use of cow’s milk in diet
• Diet low in iron, vitamins and minerals
• Long-term illnesses like kidney disease
• Infections
• Surgery or accident with blood loss

While some types of anaemia are inherited and cannot, therefore, be prevented, others are actually easily prevented by taking proper care. The following are some of the things you need to keep in mind and practice to prevent the occurrence of anaemia in your newborn or child.

• If you can, breastfeed your baby from birth up to the first six months. Breast milk is the best source of iron and other vitamins and minerals for babies in the first 12 months of their life.
• Do not introduce cow’s milk to your baby’s diet before he or she is at least 12 months old. Cow’s milk does not have enough iron. Even while giving your baby cow’s milk after one year of age, make sure the intake does not exceed two cups per day.
• Most formula milk varieties are made of cow’s milk. So if you’re formula-feeding your baby instead of breastfeeding, make sure the formula is fortified with iron or consult your doctor about how to make up for this deficiency.
• Once your baby is used to eating solid foods, make sure you include iron and folate-rich foods in his or her diet. This should be continued throughout childhood as well as teenage years to prevent anaemia at any stage. Some of the most common iron-rich foods are whole grains, eggs, potato, spinach, tomato, chicken or mutton liver, etc.