Friday, December 28, 2012

Iron Deficiency

It is not uncommon for a child with DS to have low iron levels. However, there are those that are elevated as well. Therefore it is not advised to give your child supplemental iron until you have lab work supporting a deficiency. Nutrivene does not add iron to their daily supplements, so it is safe until you obtain labs. Please check any supplements you may be giving your child. Presley had polycythemia at birth, too many red blood cells making her blood very thick. This can be dangerous, so they quickly took blood out through her umbilical cord to lower the levels. By 6 months, she had developed a mild anemia as evident by a low hemoglobin, the important part of the red blood cell that carries oxygen throughout the body. I monitored this since it was only mild and by 8-9 months, it had resolved on its own. However, our one year labs revealed she had a decreased iron level of 29, normal low is 30. You will obviously have iron deficiency long before you actually develop iron deficiency anemia. The iron stores and blood levels have to drop significantly before it affects the hemoglobin. This is another important reason why children with DS need more than the traditional lab work up at 1 year old. I mention all of the above to show how a child with DS can have varied labs, especially the first year, so do not take anything for granted. A good basic lab evaluation can be found at the nutrivene website under the Education Information section, then scroll down to "blood testing sheet" or (  ) At 18 months, I requested to recheck her thyroid levels, cbc, and iron. While her CBC (red blood cells, hemoglobin, etc..) were still within the normal range, her iron level had dropped to 24. I was glad I requested the labs to be drawn, because we could begin supplementing with iron before it began to cause an actual anemia. Also, her white count was low and there were many abnormal cells with target cells, smudge cells, poikilocystosis, tear drop cells, and others. Individually, these can mean various issues, but collectively, they steered towards iron defeiciency anemia. Some of the blood cells were not being formed correctly or being released while they were still immature. I began using liquid vitamin C and Floradix, which is supposed to be gentle on the stomach and non constipating. Unfortunately, I found the latter not to be true. Presley has a history of constipation due to the low muscle tone since 2 months old. It had resolved when we began using the thermos cereal ( as recommended by the nutritionist through NACD (National Association of Child Development). I ran out the week I began using the iron supplement and after one week, she was crying and not sleeping just as she had previously when she was unable to go. I had to use a glycerin suppository for the first time to "get things going" and we are beginning the thermos cereal again today. Fingers crossed things get back to normal. As for the Vitamin C, it increases the absorption of the iron and she doesn't seem to mind the taste. While reading, I was also reminded that the circumin has iron chelating properties. This isn't good news since circumin has so many benefits. My husband and I discussed it and decided to continue at the current dose of circumin and have the labs drawn in 8 weeks. Our genetic clinic has been so gracious to give us a standing order to repeat the labs when we feel necessary. If the labs do not show progress, we will discontinue the circumin and repeat labs again in the future. Having a child with Down Syndrome is a wonderful experience, but you need stay focused on enjoying the journey and not just the destination. It can be overwhelming at times, and just when you think you can switch to autopilot for awhile, you may run into some turbulence. Many blessings, Robin Tolliver

For more information about anemia and Floradix, check out these websites:

This is some more information taken from the excellent book Super Baby Food by Ruth Yaron. Required daily intake of iron by age: birth to 6 months: 6mg; 6-12 months: 10mg; 12-36 months: 10mg; A cast iron skillet recommended. Allow sauces to simmer to increase the amount of iron absorbed. Stay away from processed foods such as white flour, ice cream, and soft drinks which contain additives (phosphates) that decrease iron absorption. Animal foods such as small amounts of meat, poultry, or fish should be given with meals containing iron rich foods to increase iron absorption. Victamin C great improves iron absorption so fresh orange juice with whole grain millet or brown rice ceral is a good combination. Get your iron from ferrous, not ferric, compounds as ferrous is more readily absorbed by the body. Unfortunately ferric is use by manufacturers because it has a longer shelf life than ferrous, so read your labels.

So these are the things I am doing to raise Presley's iron levels:

1.  Floradix oral iron supplement 7 - 10 mg daily
2.  Vitamin C 250 mg liquid with iron supplement
3.  Orange daily, attempt to give after iron supplement meal
4.  Cooking with cast iron skillet
5.  Adding more iron rich foods into her diet, to include thermos cereal, vegetables, and select meats
6.  Black strap molasses 1 tsp twice a day - super rich in nutrients and iron

Lastly, I will recheck her levels in 8 weeks after beginning the iron to see if levels are coming up.  I will also request an iron study which will include TIBC, Iron, reticulocyte count and Ferritin levels.

1 comment:

  1. My son also have iron deficiency. It started with his Autism diagnosis. Before Autism he didn't have this issue. But it seems that it is getting better with the vitamin b12 shots and iron supplementation. Thanks for sharing great post!