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Pediatric Anemia - Causes, Types, Symptoms, Diagnosis, Treatment, and Complications

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Anemia is a condition with low red blood cells count in circulation. It is not a disease but a medical condition that describes the underlying health problems.

Medically reviewed by

Dr. Faisal Abdul Karim Malim

Published At October 17, 2022
Reviewed AtFebruary 7, 2023


Anemia is a common medical condition seen in children. It is not a disease by itself but a symptom of an underlying medical condition. It occurs mainly due to nutritional deficiencies or blood loss. The main function of red blood cells is to transport oxygen to other cells with the help of hemoglobin. Hemoglobin present in the red blood cells allows them to transport oxygen to other body parts. Most children experience the symptoms when their hemoglobin levels drop below 7 grams/dL. It may be classified into iron deficiency anemia, megaloblastic anemia, hemolytic anemia, and sickle cell anemia.

What Causes Anemia In Your Child?

There are three leading causes of anemia. They are:

  • The red blood cell count is markedly decreased in the blood circulation.

  • Inadequate production of red blood cells.

  • Destruction of red blood cells.

The decrease in the circulating blood cells or hemoglobin may be due to;

  • Defects in the red blood cells.

  • Infections and some underlying diseases.

  • Nutritional deficiencies result in the lack of minerals and vitamins.

What Happens to the Body in Anemia?

Erythropoietin is a hormone produced by the kidneys which stimulates the production of red blood cells. The levels of erythropoietin and hemoglobin are inversely proportional. If the hemoglobin levels are high, then the erythropoietin levels will be lower. In the case of oxygen deficiency or tissue hypoxia, then erythropoietin is stimulated for more red blood cell production. The bone marrow produces the red blood cells and is released into circulation. About one percent of the old or defective red blood cells are removed from circulation. Anemia occurs due to an imbalance in the production and removal rates of red blood cells. However, there are two main mechanisms in anemia.

1. Increased Red Blood Cells Destruction:

  • Blood Loss: Chronic blood loss is more frequently responsible for anemia. This is because bleeding results in the depletion of red blood cells more quickly than they can be replenished, thus resulting in anemia.

  • Acute Blood Loss: Hemorrhage, trauma, or surgery.

  • Chronic Blood Loss: Chronic gastrointestinal bleeding, ulcers, hookworm manifestation, urinary losses, as in the case of renal carcinoma, benign prostatic hyperplasia.

  • Hemolytic Anemia: Hemolytic anemia occurs when the red blood cells are destroyed prematurely.

  • Iron Deficiency Anemia: It is one of the most common forms of anemia found in children. Iron is essential in the formation of hemoglobin, which is a necessary protein in red blood cells. Hemoglobin is a vital element for transporting oxygen throughout the body. Iron deficiency anemia is characterized by low hemoglobin production. It is primarily due to a diet low in iron or gastrointestinal problems leading to decreased iron absorption.

  • Acquired: Infection, hypersplenism, immune-mediated conditions, microangiopathy.

  • Hereditary: Hemoglobin disorders, defective red blood cell metabolism, and defect in the red blood cell membrane production as in spherocytosis.

2. Defect in the Erythropoietin Mechanism:

  • Microcytic anemia.

  • Normocytic anemia.

  • Macrocytic anemia.

What Are the Common Types of Anemia in Children?

Anemia in the pediatric age group is classified based on the size of their red blood cells.

  • Microcytic Anemia: The child’s red blood cells are smaller than usual. Microcytic anemia is mainly due to iron deficiency.

  • Normocytic Anemia: The red blood cells are normal in their physiological appearance. The reason for normocytic anemia is multifactorial, and special blood tests are required to diagnose this type.

  • Macrocytic Anemia: In macrocytic anemia, the cells are comparatively larger than usual. It is mainly due to the deficiency of vitamin B12, and it is one of the rarest types of anemia.

What Is the Normal Hemoglobin Level?

The values lesser than the mentioned range are considered anemia.

  • For Males: 13.5 to 18 grams/dL.

  • For Females: 12 to 15 grams/dL.

  • In Children: 11 to 16 grams/ dL.

What Are the Symptoms a Child Faces During Anemia?

Generally, the children are asymptomatic in mild cases and are often difficult to diagnose. Here are some common features that you will notice in your baby.

  • Pale, yellow skin, cheeks, and lips.

  • The inner lining of the eyelids and nail beds looks light pink in color.

  • Fatigue and weakness, dizziness.

  • Often irritated, taking frequent naps.

  • Sore tongue, delayed wound healing.

  • They are more prone to jaundice due to the destruction of the red blood cells. They have dark-colored urine.

In severe cases of anemia, you may notice,

  • Headaches.

  • Rapid heartbeat and breathing.

  • Swollen hands and feet.

Who Is More Prone to Getting Anemia?

The risk factors for pediatric anemia are:

  • Preterm or low birth weight babies.

  • Poverty.

  • Too much consumption of cows or bovine milk.

  • Nutritional deficiencies, less iron in the diet, and an imbalance of minerals and vitamins.

  • If the child has undergone any surgery or blood loss due to trauma.

  • Chronic illness or infection.

  • Presence of genetic blood disorders running in their families, such as sickle cell anemia.

How to Diagnose Anemia in Your Child?

Generally, pediatric anemia is asymptomatic, and routine blood investigations are required to confirm the diagnosis. The tests advised are:

  • Hemoglobin and Hematocrit Tests: This is one of the screening tests to diagnose anemia in children and adults. The hemoglobin test measures the hemoglobin content in the blood. The hematocrit measures the percentage of red blood cells in the body.

  • Complete Blood Count: It checks the red blood cells, white blood cells, and platelets. Hematocrit and hemoglobin are also included in this test. The blood is collected through a needle inserted into the vein of the child’s arm. The blood is drawn in a syringe, or sometimes the blood through a needle prick is also done. However, this might cause discomfort to the child.

  • Peripheral Smear: A blood sample is viewed under the microscope to check for the appearance of the blood cells, normal function, and appearance.

  • Reticulocyte Count: Reticulocytes are immature blood cells. This test measures the number of newly formed red blood cells in the child’s blood. A low reticulocyte count may indicate anemia due to a lack of blood cells, and a high reticulocyte count denotes anemia due to increased destruction of red blood cells.

  • Bone Marrow Aspiration and Biopsy: Sometimes, bone marrow tests may also be required. As the red blood cells are produced in the bone marrow, a small amount of bone marrow fluid or solid bone marrow tissue (core biopsy) is done. This checks for the number, size, and appearance of the blood cells and detects any abnormalities.

  • Hemoglobin Electrophoresis: It is a diagnostic blood test used to quantify hemoglobin levels and analyze abnormal hemoglobin. It is used to identify the different types of hemoglobin (HgbA, HgbF, HgbS). Hemoglobin electrophoresis plays an important role in diagnosing sickle cell anemia, thalassemia, and polycythemia vera. This test is especially done in newborns to screen them for congenital hemoglobin disorders.

  • Iron Studies: Iron studies are a type of blood test used to evaluate the iron levels in the body. This is a common screening test in anemia to rule out iron deficiency. The iron studies mainly include serum iron levels, total iron binding capacity, or transferrin concentrations. The different components of iron studies are described below:
    • Serum Iron - It measures iron levels in the liquid part of the blood. Fluctuations in the levels might be suggestive of anemia.
    • Ferritin - It measures the iron present in the body. If the body contains less iron, it might be a sign of iron deficiency anemia.

    • Total Iron Binding Capacity - It works by measuring the amount of iron in the blood and also measures the iron that can be transported in the blood.

What Are the Possible Complications Associated With Anemia?

  • The problem is with normal growth and development.

  • Impaired neurological growth, delay in cognitive and mental development.

  • Failure of bone marrow, multi-organ failure in untreated cases.

  • In rare cases, it may result in leukemia or other cancers.

Are There Any Ways to Prevent Anemia in a Child?

The deficiency of iron is the most common cause of anemia in pediatric patients. This can be prevented by providing enough iron in their diet.

  • Always breastfeed your baby. Breastmilk serves as a good source of iron.

  • If you feed your child with formula milk, then use formula milk with iron added to its composition.

  • Nourish your baby with iron-rich foods. When you start with solid foods, include iron-rich grains, cereals, raisins, egg yolk, and meat in your diet.

  • Cow’s milk or bovine milk is not advised in children until one year of age. Cow’s milk lacks iron content. Too much cow’s milk consumption also interferes with the absorption of iron. Iron plays a vital role in the production of red blood cells.

How Is Pediatric Anemia Treated?

The treatment plan for anemia varies for each individual, depending on its cause. In some cases, no complex treatment is needed; a simple dietary change is sufficient. Some cases may require medications, blood transfusions, surgeries, and stem cell transplants. Here are some basic protocols followed in treating anemia. They are:

  • Supplementing vitamin and mineral drops or tablets to your child.

  • Dietary modifications like iron-rich foods, cereals, bread, rice, organ meats, liver, chicken, duck, leafy vegetables, broccoli, turnips, cabbage, legumes, beans, and peas.

  • Blood transfusions.

  • Stem cell transplants.

  • In rare cases, the spleen is removed (splenectomy) to prevent the destruction of the red blood cells.


Anemia occurs due to various reasons, so the ideal treatment will be to identify the root cause and then do the treatment. As pediatric anemia is concerned, iron deficiency is the major cause, so it can be easily treated in your child by providing a healthy iron-rich diet. You can ask your pediatrician for the food chart to be followed in the little ones, especially those below one year of age. This food chart will be able to provide your child with a balanced diet. If in case your child is anemic and not due to nutritional deficiencies, then seek a professional and get the underlying medical condition treated.

Frequently Asked Questions


Which Type of Anemia Is Most Common Among Children?

Anemia is the most common problem among children. In most cases, it is due to iron deficiency in the bloodstream. Thus, microcytic anemia due to an imbalance of iron is the standard type of anemia found in children.


What Are the Signs and Symptoms Associated With Pediatric Anemia?

Childhood anemia has symptoms such as irregular heart rate, trouble breathing, irritability, and fussiness. Moreover, children with anemia also have certain conditions such as jaundice. Also, delayed wound or tissue healing is seen in children with anemia.


Is It Possible to Cure Anemia in Children?

If a child is suffering from anemia due to a lack of nutrition, it can be cured with diet improvement and does not require any long-term care. Moreover, if a young one is suffering from any fatal condition or genetic mutation causing anemia, they might require long-term care. Moreover, in such cases, doctors may recommend anemia-specific plans to the children with regular follow-ups.


What Is Iron Deficiency in Children?

Iron deficiency is quite commonly seen in young ones. When the bloodstream does not have enough iron, this type of anemia is caused. Children with this deficiency often have development and growth-related delays along with other symptoms.


What Is the Most Efficient Way to Cure Anemia?

Treatment of anemia depends upon the type and severity of anemia. Iron deficiency anemia is usually treated with iron supplements and diet changes. On another hand, aplastic anemia, or sickle cell anemia, is usually managed with blood transfusion or bone marrow transplant. Other than that, sickle cell anemia treatment includes antibiotics, folic acid supplements, painkillers, and intravenous fluid administration.


How to Improve Iron Levels in Children?

The iron levels in children can be improved by changing their diet. For instance, pureed meat and beans are great sources of iron, and children can get plenty of iron from it. For older children, red meat, chicken, fish, spinach, and beans are good sources of iron that can improve their health.


When Is the Best Age to Check for Anemia in Children?

As per the American Academy of Pediatrics (AAP) the best suitable time to screen for anemia is between 9 to 12 months of age in children. However, if the patient is at risk and showing severe signs, the second and third screening time is 1 and 5 years. It is totally up to the pediatrician and the condition of the child when to schedule a screening.


What Are the Most Common Etiological Factors Responsible for Childhood Anemia?

Different types of anemia have different causes. However, the most common causes responsible for childhood anemia are the following:
 - Iron, folic acid, or vitamin B12 deficiency.
 - Genetically inherited.
 - Autoimmune disease.
 - Medications.
 - Bleeding.
 - Infections. 


How to Manage Anemia in a 3-Year-Old Child?

Anemia can be managed by ensuring a balanced diet. The diet should be rich in vitamin C and iron, such as red meat, vegetables, or fruits. In severe conditions, the healthcare provider might suggest iron drops or pills for several months.


Is Childhood Anemia Fatal?

The relationship between anemia and child mortality rate seems to be completely dependent on the severity of the condition and the type of anemia. For instance, anemia brought on by nutrition deficiency can be cured by managing dietary requirements. However, if the anemia is left unmanaged, there is a possibility that it can cause life-threatening conditions.


What Are the Precautions Parents Should Take for Childhood Anemia in Their Children?

If anemia is left untreated, it can give rise to serious conditions. Parents should take extra precautions to prevent them from rising in the children suffering from anemia, such as:
 - To avoid infection, parents should maintain extra care about maintaining hygiene and hand wash habit.
 - Avoid cow’s milk in breastfeeding infants.
 - Diet should rich in iron and vitamin C to avoid this condition. 
 - Children who are already suffering from this condition should be taken for regular follow-ups. 


What Is the Optimum Level of Iron in Children?

Infants between the age of 7 to 12 months require 11 milligrams of iron in a day. Toddlers between the age of 1 to 3 years require 7 milligrams of iron in a day. Young ones around the age of 4 to 8 years require 10 milligrams of iron in a day. And children older than 9 years need 8 milligrams of iron in a day.


Which Drinks Give the Highest Iron?

The following drinks have the highest levels of iron in them:
 - Prune juice.
 - Beetroot juice.
 - Pea protein shakes.
 - Pumpkin juice.
 - Spinach smoothie.
 - Mulberry smoothie. 


What Is the Reason for Giving Oral Iron Supplements to Children?

Iron in the body plays an essential role in the production of hemoglobin and myoglobin. Moreover, these are very important in maintaining oxygen levels in the blood. If a patient is suffering from severe iron deficiency, he might require supplements to regulate the body’s function.


What Is the Recovery Time for Anemia?

The severity and the type of anemia plays a role in determining the recovery time from anemia. If a patient is suffering from iron-deficient anemia, it usually takes 2 to 6 months for them to recover after starting the treatment. The rest of the type might take longer than 12 months to recover.
Dr. Faisal Abdul Karim Malim
Dr. Faisal Abdul Karim Malim



pediatric anemia
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