Mens Health Blog. Medical Blog

Anaemia is common in children, especially in the older baby and toddler age group.

Cause

There are three main causes of anaemia. By far the most common is a deficiency of iron in the body. Iron is essential for the formation of haemoglobin, the part of the red blood cell which carries oxygen around the bloodstream. Far less common causes are decreased production of red blood cells (aplasia — for example, in certain chronic diseases), or excessive destruction of red blood cells (haemolysis — for example, in some acute severe infections).

Iron deficiency in children is most often due to inadequate iron intake. Normally a baby has enough iron stores from his mother to last for the first 6 months of life, although if he was born prematurely or has been sick, the stores will be exhausted before then. After that he requires iron to be part of his diet. Usually at around 6 months of age, the baby is introduced to solids such as cereals, vegetables, eggs, and later on, meat, all of which contain iron. However, babies who are on cow’s milk and who drink excessive quantities often have insufficient iron in their diet. Cow’s milk is a poor source of iron, and in addition if a baby drinks too much milk his appetite for solids is diminished. This problem rarely occurs in breastfed babies, or those who are on formula feeds (because these contain iron).

Clinical features

The child with anaemia will appear very pale. A toddler may exhibit lethargy, but this may not be obvious, given his usual high energy levels. Some babies and toddlers with iron deficiency are irritable and difficult to manage. If the anaemia is caused by something besides iron deficiency, then specific features of that condition may be present.

Investigation are essential in any child with anaemia to find out its cause. Usually blood tests are all that is necessary, but sometimes other tests are performed as well.

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TOE WALKING

The most common reason for a young child walking on tiptoes is that of sheer habit. Rarer causes include tight heel ligaments present from birth, and cerebral palsy. If your child is toe walking out of habit, you can play an important role in improving his gait by playing games like walking on the heels or heel-to-toe walking. This condition usually improves with time and does not require treatment. If you are at all concerned, consult your doctor.

SPRAINS

A sprain is an overstretching or tear of a ligament and can be very painful. It can result from a fall or a sporting injury. Although common in adults, sprains are less likely to occur in children due to greater flexibility of their ligaments and a fracture should always be suspected if your child has an area of swelling and tenderness over a bone after injury. First aid treatment until you get him to a doctor includes placing an ice pack over the affected area to reduce the swelling and pain, splinting the limb and keeping in elevated.

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If Still’s disease is suspected, your doctor will usually refer your child promptly to a paediatrician. Hospital admission may be advised so that the necessary investigations can be performed and appropriate treatment started without delay.

The main aim of treatment is to allow your child to lead as normal a life as possible. For this to happen, pain needs to be kept to a minimum and the joints kept functioning to the best of their ability. Muscle strength must be maintained with specific exercises. Bed rest is advised only during periods when the illness flares up. Physiotherapy is essential, and night splints may be fitted to help prevent the joints from becoming frozen in awkward positions. Massage and hydrotherapy can also ease pain and encourage flexibility. Pain relief is vital and may be aided by the use of painkillers or anti-inflammatory medication. The short-term use of steroids is sometimes recommended for severe flare-ups. Use of these drugs should always be under medical supervision. If your child has certain deformities due to the illness, an occupational therapist can assist with specific aids and can suggest helpful modifications in the home.

The general outlook for children with Still’s disease is, on the whole, good. The illness does not usually continue into adulthood, and rarely leaves severe long-term deformities.

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The term rheumatoid arthritis covers a group of illnesses, and some medical specialists do not believe that there really is a juvenile form of the rheumatoid arthritis which is seen in adults. It affects approximately 1 in 1500 children, and girls are affected more often than boys.

Cause

The cause for Still’s disease is unknown.

Clinical features /

Although the joints are most often affected in Still’s disease, there may also be inflammation of the eyes, and a characteristic pink rash on the face, limbs and trunk. At the onset of the illness your child may have swelling of one or two large joints, such as the knees, wrists or elbows. He may complain of pain and stiffness in these joints especially upon waking in the morning. He may also have a mild fever and feel generally unwell or weak. Lymph glands, especially in the neck , may be swollen. Smaller joints such as those in the fingers sometimes become swollen and painful.

When to see your doctor

• if your child has unexplained pain or swelling in one or more joints which lasts for more than 2-3 days;

• if your child has an unexplained fever or rash and is generally unwell.

Investigations

X-rays, blood and urine tests are usually performed in order to confirm the diagnosis of Still’s disease.

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