Well this topic has certainly got us all talking. My inbox overfloweth! Good. Because in the current online climate of ‘Sacred Super Foods’ for kids, this conversation has to happen. I’m not batting for ‘beige baby foods’, however, with trends like this, my concern is that the kernel of truth they might have been based on, has been buried under a mountain of marketing and opportunities for monetisation. In my last blog I ruffled some serious feathers by saying, contrary to popular perception – iron deficiency & iron-deficiency anaemia is not a universal experience in Australian & NZ pre-schoolers. One of the common questions I had in response to this was, ‘but is this just being missed in most because so few are actually having their iron tested?’ Great thought and the answer to this and to my opening question: Are We Under-testing Toddlers, more generally, is….
No
In addition to, ‘name a parent that is going to opt for any not strictly necessary pain or stress for their child, there are some other solid reasons not to reflexively refer for testing
🧪Major misconceptions about which parameters are accurate at each age, e.g. Serum B12, even Transcobalamin II? – absolutely not.
💩Misuse of adult testing in paediatric patients, e.g. microbiome & gut tests only validated in individuals > 18yrs 😲😤
📈Even in those more tried & true tests like LFTs, Iron studies, reference ranges are ‘descriptive’ not what’s actually desirable, & popular ‘goals’ like S Ferritin of 50 mcg/L without foundation 🤯
🩸🩸 Every blood draw takes a little more iron & given it’s like gold in toddlers, any extra loss is significant & needs accounting for
And my answer is also….
Yes
Iron is an Achilles in kids’ nutrition but it’s of course not unique in that regard…think zinc, as one example of an equally worthy worry!
🎢But when the RDI suggests 1-3yo need MORE iron than men, well, ‘Houston, we have a problem!’👩🚀
Therefore ‘inadequate intake’🌾 is common but how then is deficiency & anaemia not?! (10% and 3%, respectively according to the latest Australian general population research 🧪)
Which means a) somebody got something wrong here & b) we should be alert to the exception, the child that isn’t thriving & in a way that’s consistent with iron inadequacy and be proactive with pathology tests rather than the most common context, which is, ‘Well they were in hospital for tonsillectomy when they had their first blood test and lo and behold they’re anaemic!”
But if you’re going steal some blood, you better be certain you know what to look for, right?! Because let me repeat…kids are not little adults…certainly not when it comes to assessment either! Our recent ‘Pair of Paediatric Anaemias taught us all about accurate interpretation and how it can identify individualised aetiology but also completely personalises the prescription.
The work-up of each sibling, which includes a checklist of 6, often unseen, factors that drive iron deficiency in kids, reveals what the children do have in common and what sets each apart and in turn identifies differences in the course of action that should follow.
Along the way you are offered an opportunity to review in detail your knowledge of iron homeostasis and how to read pathology results from this informed place, as well as learn something new about this mineral’s unique regulation at every age & stage of childhood. This recording comes with a separate clinical tool which creates a framework for understanding all the real reasons behind iron deficiency in other paediatric patients in your practice. It is a bumper offering, with bonuses galore!
You can purchase this Cracking the Case episode: A Pair of Paediatric Anaemias: Forecasting & Fixing Iron Issues here.
