Take care of children with iron deficiency anemia

2021-01-30 12:00 AM

It is necessary to prevent iron deficiency anaemia from the very beginning, right from the time the baby is in the fetal period, pay attention to the children at risk such as premature babies, twins

General perception

anaemia is a decrease in the amount of haemoglobin (Hb) or a gap in a unit volume of blood, haemoglobin or a gap is lower than the normal limit of a person of the same age. According to the World Health Organization, anaemia when haemoglobin is below the following limit:

Children 6 months - 6 years old: Hb less than 110 g / l.

Children 6 years - 14 years old: Hb less than 120 g / l.

Adult: Male: Hb under 130/1. Women: Hb below 120g / 1. Pregnant women: Hb less than 110 g / 1.

Iron deficiency anaemia

Iron deficiency anaemia is the most common type of anaemia among young children. The disease occurs mostly in children from 6 months - 2 years old.

Recall iron metabolism:

Iron is an important component of haemoglobin, essential for life.

The amount of iron in the body is very small: in infants there are about 250 mg of iron, in the adult body there are 3.5 - 4.0 g of iron.

Food is the source of iron for the body. Iron is absorbed in the entire digestive tract, especially in the duodenum and first segment of the small intestine.

The need for iron absorption varies according to body development:

Children 3 - 12 months: 0.7 mg / day.

Children 1 - 2 years: 1 mg / day.

Older age, stage: 1.8 - 2.4 mg / day.

Iron excreted less in faeces, urine, bad surgery, peeling cells in the skin, mucosa, nails, menstrual cycle.

Reason

Lack of iron supply

Iron-deficient diet: Lack of breast milk, prolonged meal intake, lack of food of animal origin.

Premature babies, underweight at birth, twins (little iron reserves are provided through placenta circulation).

Poor iron absorption

Reduce stomach acidity.

Prolonged diarrhoea.

Malabsorption syndrome.

Malformations in the stomach - intestines.

Loss of iron too much: due to gradual, chronic bleeding such as hookworm, gastroduodenal ulcer, intestinal polyps, nosebleeds, genital bleeding.

Iron demand is high: during the period of the rapid growth of the baby, premature babies, cold age, menstruation without increasing iron supply.

Symptom

Symptoms are common

Symptoms usually occur in children from 6 months of age but can occur as early as 2 - 3 months in premature babies, giving birth to twins.

Blue skin, pale mucosa slowly.

Fatigue, lack of activity.

Children with poor appetite, stop developing weight, or have digestive disorders, are susceptible to infections.

Symptoms of atrophy of the mucosa and tongue spikes, difficulty swallowing, and brittle flat nails are uncommon in children.

Test symptoms

Iron deficiency anaemia is characterized by hypochromic, a small gap in the bridge. Haemoglobin decreased more than the number of gap holes.

Serum iron decreased <10 p, mol / l (normal 11 - 28 p, mol / l).

Prevention

It is necessary to prevent iron deficiency anaemia early, right from the moment of the fetus, to pay attention to children at risk such as premature babies, twins, children under 3 years old, children with lack of breast milk and mother’s pregnant mother.

During pregnancy, feeding mothers with iron-rich diets, pregnant mothers with iron deficiency anaemia are treated with iron preparations.

Nutrition education for nursing mothers, ensuring that babies are breastfed, supplementing with juice from 2 to 3 months, supplementing with plant and animal foods.

For premature babies, twins and lack of breast milk, milk, iron-fortified foods or preventive treatment with iron preparations 20 mg/day from month 2.

Early treatment of diseases that reduce absorption such as helminthiasis, diarrhoea, chronic bleeding diseases.

Care planning

Human determination

Question:

When did you find blue-skinned children? Happened slowly or suddenly? Progression level?

Are there signs of blue skin? As gastrointestinal signs: abdominal pain, vomiting, gastrointestinal disturbances, prolonged diarrhoea; Signs of bleeding: bloody passages, prolonged bleeding genitals.

Maternity history: term or premature birth? Twins?

Nursing history: Is there enough breast milk? What month to eat Sam? What is the Sam diet?

History of diseases: associated diseases such as hookworm, prolonged diarrhea, gastric - duodenal vomiting ...

The patient has anorexia, fatigue? Dizziness in older children?

Examination:

Skin, mucous membranes: the level of green skin, pale mucosa reflects the degree of anaemia.

In iron deficiency anaemia pale blue skin much, moderately pale mucous.

Breathing Count: detect shortness of breath due to anaemia.

Pulse count: detect signs of heart failure due to anaemia.

Measure blood pressure, temperature.

In some cases, feces must be examined: nature, color, parasite test.

Diagnosis squirrel

Pale blue skin due to anaemia.

The child is tired, less sedentary due to anaemia.

The risk of heart failure due to the heart working to compensate for a long time due to anaemia.

Nutritional deficiencies due to lack of hematopoietic factor are iron.

Careful plan

Children tired, sedentary due to lack of blood:

Supports to increase blood flow to the brain:

Lie resting in bed, head low position to increase blood flow to the brain.

Do not let children exert themselves: help children with walking or activities, remind children not to run or jump a lot.

Increased hematopoiesis:

Guide children to take iron preparations.

Carry out blood transfusion orders (if any).

Guide to eating plenty of protein, vitamin C, folic acid.

Follow medical orders.

Evaluation of the progression of anaemia:

The level of pale skin, paleness of the mucosa increases or decreases.

Monitor bleeding levels (if any).

Monitor the whole condition, pulse, blood pressure.

Re-test blood count after 1 week, 2 weeks of treatment: based on the number of clefts, the number of gaps and the amount of haemoglobin to evaluate the progression of anaemia.

The risk of heart failure due to the heart working to compensate for a long time due to anaemia:

Let the patient lie absolute rest in bed, avoid exertion.

Perform medical orders for blood transfusion.

Carry out cardiac medication (if any).

Carry out the oxygen-breathing command (if available).

Monitor pulse, blood pressure, breathing rate.

Keep track of the amount of urine.

Nutritional deficiencies due to lack of clotting factor iron:

Give the patient a liquid, high-energy diet, especially foods high in iron such as lean meats, egg yolks, green vegetables, and juices.

Carry out medical orders to increase blood-forming ability: iron tablets.

Give the child iron salts, valence iron salts 2 more easily absorbed. Effective dosage is 4-6 mg / kg / day. Can be used:

Iron sulfate: 20 mg/kg/day, divided 2-3 times, taken between 2 meals (because phosphates, phytates reduce the absorption of iron).

Or iron gluconate: 40 mg / kg / day, divided 2-3 times, between 2 meals.

Duration of treatment 8 - 12 weeks, can be longer.

Supplementing with vitamin C increases the absorption of iron.

Pay attention to explain to families and patients that when using the child's stool snail is dark gray, constipation may accompany. In case of an overdose that can cause vomiting, diarrhoea, the dose should be reduced.