Fu Bao was taken by his mother to do a routine child care physical examination of 8 months old, a blood routine found that there was actually anemia (the results see below), the doctor suggested supplementing iron, the mother could not understand, how did the white and fat Fu Bao anemia?
Ask carefully, it turns out that the mother thinks that the baby's stomach is relatively young, can not digest the meat, it will take several months to add.
Therefore, while insisting on breastfeeding, since the age of 6 months, since the addition of complementary foods, he has been giving the baby a variety of puree vegetables, fruit purees, high-speed rail rice paste (25g per day), an egg yolk, thin porridge and so on.
No.1
Why does Fubao have anemia?
Fubao's mother takes the baby full-time and has been insisting on feeding breast milk, breast milk is still more, and the baby eats more.
However, the iron content in breast milk is actually very low, usually only 0.3-0.4 mg/L (800 ml of breast milk as an example, providing iron intake of 0.32 mg).
For babies within 6 months of age, the iron consumed does not mainly come from food, but the inventory that the mother hoards for the baby in the second and third trimesters of pregnancy, which is equivalent to saving a small iron warehouse in the body during the fetal period, so the daily iron needed by the baby before the age of 6 months is only 0.27mg / day.
But after 6 months, the baby's small iron library has been almost exhausted, and the iron provided in breast milk cannot meet the baby's daily iron needs (for infants after 6 months of age, the recommended amount of iron per day is 11mg / day), so the baby needs to ensure iron intake through complementary foods.
Fu Bao mother has doubts again, the baby from 6 months later, has been eating high-speed rail rice noodles, now basically can be guaranteed to eat about 25g a day, plus a day of egg yolk, will there be a lack of iron?
Let's take this net red high-speed rail pure rice noodle purchased by Fu Bao Mama as an example to calculate how much iron it contains.
In the mainland's infant cereal supplementary food standards, the maximum iron content allowed to be added to rice flour is 8mg/100g, and this net red high-speed rail rice noodle contains 5.75mg of iron per 100g, which is in line with the national standard.
Fubao eats 25g of this rice flour every day, and the intake of iron is 1.44mg, which is still far from reaching the recommended amount of 11mg of iron per day.
So if you add the "net red iron artifact" egg yolk that Fubao consumes every day, is the intake of iron not enough?
Unfortunately, there may be some disappointment in everyone.
The iron content in the egg yolk is not so high, about 7mg/100 grams, and the yolk content in a 50g egg is about 15g, and the iron content is 1.05mg.
Moreover, the iron in the egg yolk is iron phosphate, which is a non-heme iron, and the utilization rate is only 3%, so the iron intake in Fubao's daily diet is not enough.
No.2
How to determine whether it is anemia caused by iron deficiency and not poverty? Need to check trace elements?
To determine whether iron deficiency is, we can first see if the child has these high risk factors for iron deficiency, such as:
Whether there is anemia during the mother's pregnancy; whether the child is born premature, twin, or low birth weight; whether the child's daily diet is not enough iron; whether it grows faster; whether there is chronic blood loss or long-term diarrhea.
In addition, experienced pediatricians can usually make a preliminary judgment from a blood routine checklist whether it is anemia caused by iron deficiency or thalassemia, although both of which are small cell hypochromic anemia, but the blood cells of poor ground are more obviously "small and numerous".
Here is a simple judgment index, the Luojia index, which refers to the use of the average red blood cell volume (MCV) divided by the number of red blood cells (RBC).
If the result is less than 13, there is a high suspicion of poverty, and if the result is greater than 14, iron deficiency anemia is more likely.
For example, in Fubao's blood routine results, the Luojia index is 16.5 (69.5/4.21), which is greater than 14, and at the same time, there is a history of fast growth and insufficient iron intake, and the parents are not poor, considering that Fubao is iron deficiency anemia is more likely.
Because Fubao has anemia at present, the doctor recommends first supplementing iron treatment for one month, and then reviewing the blood routine, if the results after one month show that the Hgb level has increased by at least 10g/L, then Fubao can be further diagnosed as iron deficiency anemia.
So fubao needs to check a trace element first to see if it is iron deficiency?
The answer is no!
It is not accurate to use trace element results to determine whether iron deficiency is determined, and according to the current medical history and characteristics of Fubao's blood routine, it is possible to diagnose treatment first to see how effective it is.
If you really want to give your baby a test to confirm the diagnosis, it is recommended to draw blood to check serum iron and ferritin, rather than iron in trace elements.
No.3
Is food supplement ok?
Earlier we analyzed that the iron intake in FuBao's diet is not enough, that is, he also needs to consume more iron from other complementary foods.
Red meat (such as pork, beef, lamb) is an iron-rich ingredient, such as 100g of beef iron content of 3.3mg, the most important thing is that most of the iron in red meat is heme iron, better absorbed and utilized than non-heme iron (inorganic iron) (absorption rate of more than 20%), in addition to synergistically increase the absorption of inorganic iron.
Therefore, the guidelines of the world generally recommend that the first bite of complementary food added to the baby should be rich in iron food, such as high-speed rail rice flour or red meat puree, that is, the baby should be given as soon as possible to "open the meat", on how to make the baby's first bite of meat puree, please refer to popular science.
How to prepare your child's first bite of "minced meat"?
In addition, the blood, liver, etc. of healthy animals are also iron-rich foods, and the absorption rate is high.
For example, the iron content per 100g of pig liver is 25mg, and the absorption rate is as high as 22%, but at the same time, it should be noted that the liver is rich in vitamin A (the content of vitamin A in 10g of pig liver is almost up to the recommended amount of vitamin A per day for infants), in order to avoid excessive intake of vitamin A, the intake of the liver should be controlled and should not be eaten.
At the same time, in order to promote the absorption of iron, it is also necessary to pay attention to the intake of vegetables and fruits rich in vitamin C, such as oranges, kiwis and so on.
At present, Fubao's blood routine has appeared mild anemia, so it is not enough to correct it through diet, and it is necessary to choose iron to supplement.
No.4
What iron to choose? How to eat?
There are all kinds of iron agents on the market, and Fu Bao's mother is dazzled and does not know how to start. For information on how to choose iron, please refer to Popular Science.
Do children need iron supplements? How to choose iron?
Let's see how Fubao should supplement iron: Fubao is 8 months old, weighs 10kg, and the blood routine is shown as mild microcytic anemia (Note: The hemoglobin reference value of children at different ages is not the same, zhuozheng's blood routine reference value is the latest blood cell national standard introduced by the mainland in October 2021), suspected iron deficiency anemia is likely, and empiric iron supplementation is treated.
The specific method is to supplement 3mg/kg of iron per day (according to the weight of Fubao, that is, 30mg of iron per day), once a day, in the morning or between meals.
Iron can be taken alone or with water, juice, or acidic fruits (such as citrus, strawberries, or applesauce), taking care to make sure your baby eats the full dose. Breast milk or other dairy products should be avoided one hour before and two hours after each dose.
The reason why 3 mg/kg elemental iron is recommended here, rather than a higher dose, is because a large number of clinical trials have confirmed that this dose is effective and more easily tolerated by most children.
Let's take a look at the several iron agents that Moms often choose:
Healthy spleen blood granules
Contains ingredients such as ginseng, poria, baishu (stir-fried), chicken inner gold (fried), ferrous sulfate, etc., each containing 20mg of iron. If you choose this iron, Fubao needs to eat a pack and a half, but we do not recommend it, because this drug is complex from the composition alone, and the side effects are not clear.
Iron protein succinate oral solution
Each 15 ml, containing 800 mg of iron protein succinate (equivalent to 40 mg of trivalent iron), Fubao needs to eat 3/4 of the amount per day, if supplemented according to the instructions, it is recommended that children take 1.5 ml per kilogram of body weight per day, that is, Fubao needs to eat one stick per day.
However, this iron agent has an old rusty smell and is not good.
Dextran iron dispersible tablets
Each tablet contains 25mg of iron, calculated according to the iron content, Fubao needs to eat 1-2 tablets a day, the tablets can be dissolved in an appropriate amount of warm boiled water and taken orally, the tablets are small in size, and the older children can also be taken directly with water, without obvious rust smell.
In addition, many mothers like to choose the iron of Haitao, so be sure to see the iron content clearly, give the baby the appropriate dose, and must not be supplemented at will, such as - German iron Ferrum Hausmann.
German iron Agent Ferrum Hausmann
As an Internet celebrity's sea tao iron agent, German Ferrum can be described as a combination of thousands of advantages. Its main ingredient is iron (III) hydroxide polymaltose complex, which belongs to the polysaccharide iron complex, with high iron content (1 drop containing 2.5mg of iron), good taste (milk flavor), small side effects, and the price is not expensive. If Fubao takes this iron, it needs to take 12 drops a day.
The fly in the ointment is that it contains a small amount of methylparaben and propylparaben, two food additives, and there is some controversy about safety, but "leaving the dose to talk about toxicity is a hooligan", and some scholars believe that the amount added is not enough to cause harmful effects on the human body.
In general, there is no perfect iron, to weigh whether the child can eat, iron supplementation effect is good, side effects are small, it is best to be economical... Therefore, it is recommended to fully communicate with the doctor, weigh the pros and cons, and then make a choice.
No.5
How long does iron take?
The blood routine is reviewed 4 weeks after initiation of iron supplementation therapy to confirm your child's response to iron treatment. Once efficacy is confirmed (but not yet at normal levels), iron therapy and monitoring should be continued, and the blood routine should be retested at 3 months.
Iron therapy should be at least 3 months, and many children may even need a longer course of treatment to replenish their iron reserves. In general, iron therapy should be continued for at least 1 month after hemoglobin reaches the corrected age range.
Attached: Manifestations of effective iron supplementation therapy
For mild iron deficiency anemia (IDA) with Hgb ≥ 90 g/L: 4 weeks after iron supplementation, Hgb levels increase by at least 10 g/L;
For Hgb