Paediatricians repeat this adage often. It acts as an important reminder about adjusting dose for children’s reduced weights. But that’s only the start of, what is, an almost entirely different solar system we need to immerse ourselves in. Diagnosis is different too. Because children demonstrate physiological responses and regulatory systems not seen in others. They’ve got a whole different rulebook they’re playing by & you need to know it. Then there’s the absence of the first-person narrative in infancy. And once verbal, definitive symptoms are scarce, instead the ubiquitous and ambiguous ‘sore tummy’. What can the child tell you themselves and accurately? All together these lead to a much greater reliance on the practitioner’s astute observation of signs. And what about paediatric pathology interpretation? – An entirely different beast!
That’s if there’s to be any blood🩸spilt at all.
Name a parent that wants to put their child through any pain, worry, stress or angst that isn’t entirely necessary. Correct. As a result, results themselves are actually hard to come by. Health professionals too are often averse to recommending testing unless absolutely necessary, instead they’re performed opportunistically – the child’s in hospital for something else; “Let’s take a look at some labs”, they say. That’s how we often end up finding out about things. That’s how this family, that we discuss in our Cracking the Case session, found out their youngest had anaemia. Which triggered a test in the older seriously-fatigued sibling and *bingo* we then knew one more thing they both had in common!
But in spite of us doing this baby-thing blind most of the time.
As in, we test everything while they’re inside ‘the temple’ while pregnant, and then once they’re out we’re winging it!
Iron issues and anaemia are actually uncommon.
As in, we test everything while they’re inside ‘the temple’ while pregnant, and then once they’re out we’re winging it!
Iron issues and anaemia are actually uncommon.
You heard me. Contrary to popular perception, babies are born with a whopping iron surplus and are built to build blood. Which is only trumped by the need to survive infections. And yes the clever among you recognise that the two do have conflicting iron agendas! So when we know a child actually is anaemic we should be all-ears and alert to all contributing causes (yes, plural). Beige baby foods have been the mainstay instead of ‘premasticated everything’, in so-called developed countries, ever since the agricultural revolution. Under-consuming iron is the norm in pre-schoolers and yet anaemia is uncommon. So diet alone is unlikely to be the full explanation…look again. We have had the great privilege to present two such cases that have everything to teach us about how to listen to these stories and look at the labs through the very distinct lens of paediatrics – not only in terms of iron studies and FBEs but white cell differentials and more.
Because our babes’ blood is precious, accurate interpretation is essential.
But how to read non-fasting collections? Oh yes kids keep it really real!
And how do we manage without repetition of the labs for monitoring their response to treatment?
Which understandably seems excessive to mum, especially when ‘they seem better now’.
But how to read non-fasting collections? Oh yes kids keep it really real!
And how do we manage without repetition of the labs for monitoring their response to treatment?
Which understandably seems excessive to mum, especially when ‘they seem better now’.
Well come along and find out…
A Pair of Paediatric Anaemias
Two young siblings both present with anaemia. With the same parents, similar birth stories, breastfeeding pattern, same introduction of solids and ongoing food patterns, can we assume that the underpinning cause is the same? And like all young kids everywhere, do they just need ‘more iron’? While we’re led to believe ‘iron issues’ are simply ‘par for the course’ in infants & preschoolers, rates of anaemia in countries such as Australia in this age group are actually <5%. Therefore instead, we should view any anaemia presentation, and more broadly, every ‘iron issue’, as a call to action to identify all the causes & contributions unique to the individual.
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.
