The Changing Face of Anemia in Infancy
Elinor A. Graham MD, MPH1
1 Acting Assistant Professor, Department of Pediatrics, University of Washington School of Medicine, Harborview Medical Center, Seattle, WA.
Introduction
The pattern of anemia in infancy is changing in North America. The major factors contributing to anemia include iron endowment at birth, adequacy of dietary iron, frequency of infection, and the genetic background of a child. The characteristics of all of these factors are changing in the pediatric population. As more premature infants survive, their inadequate birth endowment of iron results in iron deficiency at an earlier age. Because of widespread use of iron-fortified formulas or iron supplementation with breastfeeding, iron deficiency now causes less anemia in the first year of life. As iron nutrition of infants has improved, anemia associated with infection has been identified more frequently. Increased work force participation of mothers has resulted in more exposure to infections by infants in child care. An increase in the percentage of children who are of Asian and African genetic backgrounds has increased the prevalence of inherited hemoglobin disorders among children. Newborn screening for hemoglobinopathies has resulted in more frequent identification of these disorders.
Decline in the socioeconomic status of children in the United States adds to the complexity of this picture. More than one factor often produces anemia in an infant from a poor family, and the anemia may have a greater impact on the psychosocial development of a child from a low-income background.
