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Illnesses & Symptoms


We screen all of our patients for anemia (low red blood cell count) at 12 months of age and most again during the teenage years.

Why does my child need to have blood drawn?

Many parents question what anemia is and why we test for it. The American Academy of Pediatrics recommends screening for anemia because most often there are no symptoms of this common childhood problem. Anemia often does not have any symptoms when mild, but can cause fatigue, weakness, pale skin, dizziness, mental slowing, developmental delays, rapid heartbeat, shortness of breath, irritability, poor appetite, numb or cold hands and feet, and headaches as it becomes more severe.

What causes anemia?

Anemia means that the number of red blood cells in the body is below normal. It can be caused by not making enough red blood cells, too much breakdown of red blood cells and loss of red blood cells (such as with heavy bleeding). Some causes are hereditary, such as sickle cell anemia, others can be from illness, poor nutrition, or injury. Treatment of anemia depends on the cause.

The most common type of anemia is from iron deficiency. Iron is needed for the body to produce red blood cells. Without enough iron, the body cannot make enough red blood cells to bring oxygen to organs and tissues. A diet high in iron can help prevent iron deficiency anemia. It is now recommended that all infants who are exclusively breastfed begin iron supplements by 6 months of age. Infant formulas with low iron are not recommended.

After 1 year of age, your child should not drink more than 24 ounces of cow’s milk a day (about 3 cups) so that he or she has an adequate appetite for solid iron-containing foods. Milk doesn't contain any iron and large amounts of cow’s milk actually causes the gut to leak small amounts of blood.

Girls can become anemic if they don't have a high enough iron intake to accommodate the extra needs due to blood loss during menstruation.

How can I prevent iron deficiency?

Eating foods high in iron or taking a routine daily supplement of iron can prevent iron deficiency. Cooking in iron cookware can increase the iron content of foods. Foods high in iron are:
  • Meats
  • Fish
  • Poultry
  • Raisins
  • Sweet potatoes
  • Lima beans
  • Kidney beans
  • Pinto beans
  • Green peas
  • Peanut butter
  • Enriched cereals and breads

How do we treat anemia?

If a child’s screening blood count shows a low hemoglobin level or small red blood cells, we will first recommend iron therapy followed by a recheck of the blood count. Iron may need to be taken for 2 to 3 months to get your child's red blood cells back to a normal level. Iron should be taken with food to prevent stomach upset. Adding the iron drops to a juice containing Vitamin C will improve iron absorption and prevent staining of the teeth. Do not give iron with milk or formula because they reduce absorption. If further testing proves another source of anemia, we treat that specific cause.

My child gets brown/grey teeth when on iron. Is this bad?

A common temporary complication of liquid iron therapy is tooth staining. If the teeth become stained, the stain can be brushed off with a small amount of baking soda on a wet cloth.

My child had black stools - is this dangerous?

The iron may change the color of bowel movements to dark green or black, but this is harmless.

Are iron supplements dangerous?

Too much iron can be dangerous and can cause serious poisoning, but giving the recommended daily amount is safe. Treat iron like any medicine: Keep it out of your child's reach. For more on iron, please see our Iron Supplements Page

How is the cause of anemia diagnosed?

When a screening complete blood count (CBC) shows that there are fewer or smaller red blood cells than normal, we need to determine why.

Any family history of anemia should be discussed with your provider.

A review of medications should be done because some may cause anemia.

Since iron deficiency is very common, all people with anemia must first take iron supplements before repeating labs. Testing is done based on the initial blood counts and any symptoms or family history.

After a period on iron therapy follow-up tests may include:

  • Repeat CBC to see if the anemia has corrected with iron.
  • Iron tests: These include total serum iron, iron binding capacity and ferritin tests, which can help to determine whether anemia is due to iron deficiency. No test is perfect when looking at iron levels because the liver stores the majority of iron in the body it is not easily measured in the blood.
  • Reticulocyte count: A measure of newer red blood cells, this helps to determine if production of red blood cells is at normal levels. If low when there is an anemia, this indicates too low of production of blood cells. If high but the anemia persists, this indicates a breakdown of red blood cells or a continued loss of red blood cells.
  • Hemoglobin electrophoresis: Used to identify various abnormal hemoglobins in the blood and to diagnose sickle cell anemia, the thalassemias and other inherited forms of anemia. It is done on all newborn screens and can be repeated if indicated.
  • Blood smear examination: Blood is smeared on a glass slide for microscopic examination of red blood cells (for size, shape, color, breakage).
  • Bone marrow aspiration and biopsy: This test is only done when indicated by other blood test results and physical exam. The bone marrow makes the blood cells. Testing the bone marrow can help determine whether blood cell production is happening normally. It is used if there is a concern for certain cancers or if the bone marrow seems to not be producing proper blood cells.
Learning about different types of anemia:
Please visit the following outside resources if your child has been diagnosed with one of the following types of anemia.

Find health information quickly in our parent toolkit.

Illnesses & Symptoms