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My 10-month-old daughter was diagnosed with anemia last month. She was prescribed three doses of iron supplementation for six weeks to bring her level back to normal. After that she should only take the normal one dose. After her six week recheck, I was told that the increased iron didn't change her level at all. I was told that she just can't seem to absorb iron and not to worry about it. I was told to just give her the one daily dose and that being anemic is just normal for my daughter. I have a hard time accepting that I can't do anything about this. Should I go to another doctor for a second opinion?
Anemia is a common problem beginning at about nine months of age. In the last trimester of pregnancy, the mother passes a large amount of iron to the baby. This iron lasts for about four to six months after which the baby needs to supply all the required iron through the food he takes. This is the reason that infants taking formula should be on one that has a good amount of iron in it (not the low-iron formulations). There are certain foods that can significantly increase the amount of iron absorbed as well as foods that can very significantly decrease the amount of iron absorbed. Breastmilk greatly enhances iron absorption in the gastrointestinal tract whereas cow's milk very significantly decreases absorption. This is one of the main reasons why it is suggested that whole cow's milk not be started until the child reaches one year of age.
However iron deficiency is not the only reason why an infant could be anemic. Anemia is a condition in which the body does not have enough normal red blood cells. This essentially occurs in one of three ways:
- The body isn't making enough red blood cells
- The body is making enough red blood cells, but they are not normal red blood cells
- The body is destroying the red blood cells at too high a rate.
Be sure a take a look at my previous answer about anemia which goes into more depth about these causes.
The fact that your child did not respond to the iron means one of two things:
- She did not absorb enough iron to make a difference. With her taking three doses a day for six weeks, the most common way she could have had that lack of absorption is if the dose was incorrect or your daughter was drinking a lot of cow's milk.
- Her anemia is caused by something else. This ought to be investigated because if her anemia is not from iron deficiency, then she certainly doesn't require iron supplementation. And in fact, prolonged iron supplementation when it isn't needed can cause problems with iron overload later in life.
Many states require as part of their newborn screen a test called a hemoglobin electrophoresis. This test looks for inherited causes of anemia. I suggest you find out if your daughter had this screen. If she did not have this screen or it does not supply the answer to the anemia, I would suggest getting a second opinion. The cause of anemia can usually be determined, and it is important to figure it out. If she is truly iron deficient, supplying the correct amount of iron to her body is critical for her behavioral and cognitive development. On the other hand, if her anemia is not from iron deficiency, taking large amounts of iron for a long time can eventually cause problems. In addition, knowing the cause of her anemia may have implications for the rest of your family. If it is an inherited cause, other family members may need to be tested.
