Soviet children’s medicine already paid attention to iron deficiency. Many children’s mothers begged them to eat liver and other products rich in iron. And the iron-containing medication Hematogen, which fortunately resembled the appearance and taste of candy bars, was mandatorily distributed in children’s recreational centers of the USSR. And it was done for a reason. And because our body needs iron for iron health in the truest sense of the word. But how to really recognize iron deficiency and how to avoid adverse effects of this condition? In our material, we will learn the answers. Sometimes the solution to the problem is:

Iron deficiency – the cause of reduced mental development
One of the first places in the structure of childhood pathologies invariably belongs to iron deficiency. According to the report of American experts Micronutrient Initiative, the lack of this substance leads to a decrease in mental development in almost 40% of infants in the world, the health and performance of about 500 million women. And iron deficiency anemia (IDA) is responsible for more than 60,000 infant deaths worldwide every year. Unfortunately, the grim statistics remains unchanged in recent years: disorders associated with iron deficiency affects 1/5-1/6 of the world’s population. And these are predominantly children. But before speaking about the correct evaluation of this phenomenon, it is necessary to say something about the trace element of interest.

Premature infants are susceptible to iron deficiency. But not only
Iron deficiency occurs already in the fetus. The accumulation of trace element occurs mainly during the last two months of prenatal life. This means that all premature infants, as well as those born at term but underweight, have little or no iron depot. A healthy infant’s iron reserve is sufficient for the first few months, and by the end of the first six months it is depleted. Sometimes even, as Professor A.F. Tur pointed out back in the middle of the last century, to the point of complete emptying. It was during this period, the children’s body needs more iron, as it is contained in the protein myoglobin, similar in structure to hemoglobin. Without these substances, normal growth of muscle mass and bone tissue is impossible.

Breast milk and formula do not protect against anemia
Thus, the need for iron is very high, especially when supplies are depleted and the intake from outside, with food, is limited. After all, its main external source – meat food – begins to be eaten no earlier than 6 months. But until then, the baby’s main food is breast milk, and it contains a relatively small amount of iron. Even with the now popular formula feeding, iron absorption is limited.

Up to 3 months of age, the need for iron is low.
To this we should add some more peculiarities. So, from birth to 2.5-3 months, the bone marrow is in a low state of functional activity, and in the child’s blood initially circulate red blood cells formed before birth and have a number of differences. This phenomenon is referred to as a physiological minimum. Such a condition is not yet associated with iron deficiency and, accordingly, does not require recourse to special medications.

Misconceptions about iron deficiency
Just one of the common misconceptions – the attempt to “treat” the physiological minimum – comes from a misunderstanding of these processes and, accordingly, is unsuccessful. Naturally, the bone marrow needs for iron during this period are small. But as the child grows towards the end of the first six months of life, the red sprout of bone marrow is already functioning more actively, and its need for iron increases. At the same time, other expenditures of this trace element increase, as it was presented above, with limited possibilities of intake. This kind of “scissors” means that the child lives on an iron balance of practically zero. The supply he receives with food is immediately incorporated into the metabolic processes, and only gradually, by the age of 1.5-2 years, is the iron depot formed. Mainly in the liver in the form of a compound – ferritin. All these features create the conditions and prerequisites for the fact that it is in early childhood that the iron deficiency state (IDS) occurs. In particular, this condition occurs in rickets, pre- and intrapartum blood loss, any type of dystrophy, protein-energy deficiency, acute digestive disorders, repeated acute inflammatory conditions, etc.

When everything is missing
There is a concept of “poly-deficiency states”, among which iron deficiency plays a leading role. Often, iron deficiency does not initially manifest itself as iron deficiency anemia, but as a precursor, referred to as latent iron deficiency (LID), which accounts for up to 70% of this deficiency. And the task of the pediatrician is to diagnose this stage of absolute iron deficiency. According to Russian authors, every third child in Russia suffers from latent iron deficiency. If LAD is not diagnosed and treated in time, sooner or later, sometimes after several years, the growing organism will develop iron deficiency. In such cases, there may be a false explanation of its cause as a consequence of frequent respiratory or other acute illnesses, dietary disorders, etc., leading to inadequate treatment tactics.

The iron cycle
What are the characteristics of iron metabolism in older children? By the age of two and beyond, the iron depot is already present. It circulates in the body according to the principle of “closed system”. With aging and the natural destruction of cells, especially red blood cells, iron is released and recirculated to synthesize new compounds, primarily hemoglobin. Part of the iron goes to the depot, exchanging for an equivalent amount of it, which also corresponds to the “vicious circle” principle. The amount of this trace element, totaling up to 5-6 grams in adults and children of the older age group, is excreted from the body. The same amount, respectively, is absorbed in the intestine from food. Given this stability of iron circulation, it is conceivable that eating disorders alone as the sole cause rarely lead to the development of iron deficiency.

There may be more than one cause of impaired iron metabolism
More often the lack of nutrition, as a very relevant factor, is combined with gastrointestinal pathology, blood loss, endocrine system disorders, and previously untreated LDH . The latter factor is increasingly becoming a very significant cause of anemia in adolescents, as well as in pregnant women, when iron requirements increase significantly. Hence, there is an important conclusion about the need for a more comprehensive evaluation of older children with iron deficiencies to determine the cause of this phenomenon. Only a combination of treatment and elimination of concomitant causative factors is the necessary reliable basis for the elimination of this pathology.

Iron deficiency: how to avoid it?
The abundance of iron-containing drugs and means of prevention sometimes makes it difficult to choose the best choice in each case. In addition, there is the problem of parents being poorly informed about the peculiarities of iron deficiency in a child’s growing body. Treatment of children with iron preparations, of course, should be prescribed by a physician, who accurately perform all the necessary preliminary studies, selection of the optimal remedy, dosage, duration of treatment and methods of monitoring its effectiveness. If the treatment of WDD should be prescribed and supervised by a doctor, the prevention of this pathology can be carried out by the parents of the child, which requires compliance with a number of simple rules and principles. The first prerequisite is a full, age-appropriate diet, including a sufficient amount of animal protein – meat food – as well as fresh fruit and vegetables. And for infants receiving nutritional formulas, these should be enriched with iron, i.e. contain more than 7 mg of iron in a liter. Also, the prevention of iron deficiency should include the use of iron preparations, which should be used preparations (Maltofer, ferrumlek, ferlatum) for a course of two months, in the absence of exacerbation of other diseases in a dose half as much as the therapeutic.