Iron deficiency anemia in children: treatment, a review of the main drugs. Iron preparations for children: rules for use and side effects Iron preparations for children 5 years old

I. N. Zakharova, N. A. Korovina, A. L. Zaplatnikov, N. E. Malova

The goal of therapy for iron deficiency anemia (IDA) is to eliminate iron deficiency and restore its reserves in the body. This can only be achieved by eliminating the underlying cause of IDA in the body.

The basic principles of the treatment of IDA were formulated by L.I. Idelson in 1981:

It is impossible to compensate for iron deficiency without medicinal iron-containing preparations.

Treatment of IDA should be predominantly with oral iron preparations.

IDA therapy should not be discontinued after normalization of hemoglobin levels.

Blood transfusions with IDA should be carried out only strictly for health reasons.

Previously, there was an opinion that iron deficiency can be eliminated by prescribing a diet containing apples, buckwheat, pomegranates and other plant products containing iron. However, in the 60s. In the 20th century, researchers proved that iron contained in foods in the form of heme (meat, liver, fish) is better absorbed in the body than from other compounds. About 90% of iron is absorbed in the duodenum, the rest - in the upper jejunum. In iron-deficient conditions, the absorption surface of the small intestine increases. Iron is absorbed in 2 forms:

heme (10%), the sources of which are hemoglobin and myoglobin, which are part of animal products (meat, fish, poultry, liver) (Table 1);

non-heme (90%), the sources of which are plant products (vegetables, fruits, cereals) (Table 2).

The amount of iron supplied during the day with food contains about 10-12 mg of iron (heme + non-heme), but only 1-1.2 mg of the trace element is absorbed from this amount. It has been established that the bioavailability of heme iron in foods is higher than that of non-heme compounds, and is 25–30%.

The majority of dietary iron is in the non-heme form. The bioavailability of iron from cereals, legumes, tubers, vegetables, and fruits is significantly lower than from heme compounds, and largely depends on the predominance of factors in the diet that inhibit or potentiate intestinal ferroabsorption (Table 3).

Despite the high content of iron in some products of plant origin, they are not able to provide them with the child's body. Substances present in foods of plant origin (tannins, phytins, phosphates) form insoluble compounds with Fe (III) and are excreted with feces. There is also evidence of an adverse effect on the absorption of iron by dietary fiber, which is rich in cereals, fresh vegetables, and fruits. In the intestine, dietary fiber is practically not digested, iron is fixed on their surface and excreted in the feces. On the contrary, ascorbic acid, animal protein (meat, fish) increase the bioavailability of iron, which increase the absorption of the trace element. It should also be noted that products from meat, liver, fish, in turn, increase the absorption of iron from vegetables and fruits with their simultaneous use.

A complete and balanced diet according to the main ingredients only allows you to “cover” the physiological need of the body for iron, but not eliminate its deficiency.

Natural prevention of IDA in children during the first months of life is exclusive breastfeeding up to 4-6 months. It is known that the concentration of iron in women's milk is only 0.2–0.4 mg/l, however, the absorption of iron from it reaches 50%, which provides the baby's need for the first 4–6 months. By the time a child's body weight has doubled (5–6 months), antenatal iron stores in his body are depleted.

In order to prevent IDA with artificial feeding, it is advisable for children at risk for the development of IDA to use mixtures enriched with iron. They are prescribed for full-term children at risk (from twins, triplets, with a large increase in weight), starting from 3-5 months of life, and for premature babies - from 1.5-2 months. The content of iron in mixtures for artificial feeding of children in the first six months of life is 3–5–8 mg/l of the mixture, and for children in the second half of the year - 10–14 mg/l.

The inclusion of complementary foods enriched with iron (fruit juices, fruit and vegetable purees, instant cereals) in the diet of children significantly increases the amount of iron that enters the child's body with food.

For children aged 4–6 months who are breastfed, and infants after 6 months of life who do not receive iron-fortified nutrition, it is advisable to prescribe iron supplements at a prophylactic dose of 1–2 mg/kg/day until 12–18 months of age.

IDA in young children has been linked to the early ingestion of high-protein cow or goat milk. It should be noted that the development of IDA in these children is associated not only with a low level of iron in cow's milk, its poor absorption, but also with the loss of iron due to microdiapedetic intestinal bleeding. Numerous studies have noted the relationship between the amount of unadapted product consumed (milk, kefir) and the severity of microdiapedetic intestinal blood loss in infants. It was noted that the sensitivity to non-adapted products decreases with age and after 2 years of life, microdiapedetic intestinal bleeding is not observed while taking cow's milk. The mechanism underlying the increased excretion of hemoglobin in the feces during the intake of non-adapted dairy products in young children is not exactly known. Some authors associate microdiapedetic intestinal bleeding with intolerance to cow's milk proteins.

The choice of a drug for the correction of IDA is of particular importance, since the duration of treatment can be from several weeks to several months. At the same time, not only efficiency is important, but also the absence of side effects and complications, adherence to ongoing therapy, especially in pediatric practice.

Currently, all iron preparations are divided into two groups (Table 4):

ionic iron-containing preparations (salt, polysaccharide iron compounds);

non-ionic compounds, which include preparations represented by the hydroxide-polymaltose complex (HPC) of ferric iron.

Therapy of iron deficiency states should be aimed at eliminating the cause and at the same time replenishing iron deficiency with medicinal Fe-containing preparations.

Therapy of iron deficiency states should be carried out mainly with iron preparations for oral administration.

Oral administration of Fe preparations:

increases the level of hemoglobin only 2-4 days later than with parenteral administration;

unlike parenteral, it rarely leads to serious side effects;

even with an incorrect diagnosis, it does not lead to the development of hemosiderosis.

Parenteral administration of iron preparations is indicated only for special indications (syndrome of impaired intestinal absorption, condition after extensive resection of the small intestine).

Requirements for oral iron preparations used in pediatric practice:

good bioavailability;

high security;

pleasant organoleptic properties;

various dosage forms convenient for patients of all ages;

compliance.

For young children, it is preferable to prescribe iron-containing preparations, produced in the form of drops, syrup. Good for children of this age group Aktiferrin (drops, syrup), Maltofer (drops, syrup), Ferrum Lek (syrup), Hemofer (drops) (Table 5).

For adolescent children, it is best to prescribe iron preparations such as Ferrum Leka (chewable tablets) or Tardiferon and Ferrogradum, which are slowly absorbed, providing a prolonged and uniform absorption of medicinal iron in the intestine. As a rule, these drugs are well tolerated by patients.

After choosing an iron-containing drug and the method of its use, it is necessary to determine the daily daily dose of the drug and the frequency of administration (Table 6).

Iron (III) preparations - HPA are used in children with IDA of different ages at a therapeutic dose of 5 mg / kg / day.

In latent iron deficiency, all iron preparations are used at half the therapeutic dose.

Prophylactic doses of iron preparations:

for children under 3 years old - 1-1.5 mg / kg / day;

for children older than 3 years - 1/2 daily therapeutic dose.

It is known that treatment with saline preparations may be accompanied by disorders of the stool, and therefore therapy with ferrous iron preparations should be started with a dose equal to 1/4–1/2 of the calculated therapeutic dose, followed by a gradual achievement of the full dose within 7–14 days. The rate of "gradual increase" of the dose to the therapeutic one depends both on the severity of iron deficiency, and on the state of the gastrointestinal tract and the individual tolerance of the drug. This technique allows you to choose an individual dose depending on tolerance and reduce the risk of side effects of therapy with iron salt preparations.

It is well known that iron salt preparations in the intestinal lumen interact with food components, drugs, hindering the absorption of iron. In this regard, iron salt preparations are recommended to be administered 1 hour before a meal. The administration of Fe(III)-HPA preparations does not require the use of a gradual dose escalation technique. The drugs of this group are prescribed immediately in a full dose, regardless of food, since food does not affect their absorption.

The therapeutic effect of oral iron appears gradually. Initially, there is a clinical improvement, and only after some time does the normalization of hemoglobin occur. The first positive clinical sign that appears during treatment with iron preparations is the disappearance or reduction of muscle weakness. The latter is due to the fact that iron is part of the enzymes involved in the contraction of myofibrils. On the 10-12th day from the start of treatment, the content of reticulocytes in the peripheral blood increases. The increase in hemoglobin can be gradual or abrupt. Most often, the onset of a rise in hemoglobin levels occurs 3-4 weeks after the start of therapy. As shown by numerous studies, the disappearance of the clinical manifestations of the disease is noted by 1–2 months of therapy, and the disappearance of tissue sideropenia occurs at 3–6 months of treatment. The daily dose of elemental iron after normalization of the hemoglobin level should correspond to 1/2 of the therapeutic dose (Table 7). Early discontinuation of iron therapy usually results in relapses of IDA. The duration of the main course of treatment with iron preparations is 6–10 weeks, depending on the severity of the identified iron deficiency anemia. The duration of the prophylactic course with iron preparations in order to create an iron depot in the body is:

with mild anemia - 1.5–2 months;

with moderate anemia - 2 months;

with severe anemia - 2.5-3 months.

Criteria for the effectiveness of treatment with iron preparations:

the appearance of a reticulocyte crisis on the 7-10th day of treatment;

increase in hemoglobin level - 10 g / l per week;

The refractoriness of iron deficiency anemia is due to the inadequacy of the prescribed therapy or anemia not associated with iron deficiency!

Parenteral drugs in the treatment of iron deficiency anemia should be used only under strict indications!

Indications for parenteral administration of iron preparations:

Short bowel syndrome.

Malabsorption Syndrome.

Nonspecific ulcerative colitis.

Chronic enterocolitis.

Parenteral preparations are best used not daily, but at intervals of 1-2 days. In this case, half the dose can be used in the first 1-3 injections.

Given the duration of ferrotherapy, the choice of drugs for the correction of IDA in young children requires special attention. Both iron salt preparations and preparations of Fe(III) - HPA of the polymaltose complex are effective in the treatment of WDN. Side effects and adverse events in oral ferrotherapy of IDA are mainly associated with excess recommended doses and are more often manifested by dyspepsia. Adverse reactions and adverse effects that may develop with ferrotherapy in children are summarized in Table 8.

Parenteral iron preparations should be used only strictly for special indications.

Transfusions of blood or red blood cells in IDA are carried out extremely rarely and strictly for health reasons. The criteria for hemotransfusion is a decrease in hemoglobin below a critical level in combination with signs of impaired central hemodynamics, hemorrhagic shock, anemic precoma, and hypoxic syndrome (Table 9). Hemotransfusion can also be carried out at hemoglobin and hematocrit values ​​above the critical ones, if massive acute blood loss occurs.

The effect of blood transfusions in IDA is short-lived. A negative effect of blood transfusions on erythropoiesis was noted. In addition, there is a high risk of transfusion infection of the recipient. In the presence of vital indications for replacement blood transfusion, preference is given to erythrocyte mass or washed erythrocytes at the rate of 10–15 ml/kg of mass. Older children are usually transfused from 150 to 250 ml. Whole blood has not been used in pediatric practice in recent years.

Prevention of IDA in children includes:

1. Antenatal prophylaxis:

all women in the second half of pregnancy, it is advisable to prophylactically prescribe oral ferropreparations or multivitamins enriched with iron.

2. Postnatal prophylaxis:

natural feeding with the timely introduction of complementary foods (meat puree from 6–7 months);

children who are formula-fed, from 2–3 months of age, the introduction of mixtures enriched with iron (12 mg / l);

Premature children, children from multiple pregnancies, born with a large body weight, having a rapid rate of weight and growth gain, from the 3rd month to the end of the first half of the year, it is recommended to take prophylactic iron preparations at a dose equal to 1/3–1/2 of the daily therapeutic dose of an elementary iron (1.0–1.5 mg/kg/day).

Vaccination of children with IDA is carried out after the normalization of hemoglobin levels.

Removal from the dispensary registration is carried out in a year.

I. N. Zakharova
N. A. Korovina, doctor of medical sciences, professor
A. L. Zaplatnikov, doctor of medical sciences, professor
N. E. Malova, Candidate of Medical Sciences
RMAPO, Moscow

Content

Many parents experience iron deficiency in children. To correct the level of the microelement, special medicines are used. Therapy is prescribed by a doctor after passing the tests. It is forbidden to start taking medications on your own.

Indications for taking iron supplements

The course of therapy is prescribed after examining the baby. Doctors detect the number of red blood cells in the blood, the level of hemoglobin. A referral for diagnostics is issued in the presence of symptoms:

• hair loss;
• fragility and foliation of nails;
• pale skin;
• seizures in the corners of the mouth;
• headache;
• skin itching;
• loss of appetite;
• sleep problems;
• severe fatigue;
• dizziness;
• weight loss;
• emotional instability.

How to choose iron supplements for anemia

Low hemoglobin is the basis for taking iron-containing drugs. After a comprehensive examination, the doctor prescribes a remedy suitable for age. Preparations for anemia are made on the basis of ferrous or ferric iron. Tablets are better absorbed, but not suitable for babies under 3 years old. Capsules load the intestines less.

In case of digestive problems, the child is prescribed droppers with iron-containing preparations. The effectiveness of treatment in this case is significantly reduced. It is forbidden to start taking medications without a doctor's prescription. All drugs have contraindications, side effects.

When choosing iron supplements for children, you should pay attention to:

• safety;
• pleasant taste (especially at a young age of the child);
• bioavailability (the ability of a drug to be absorbed);
• tolerance of the components of the drug.

The Best Iron Supplements for Children

In pharmacies, anti-anemic drugs of various forms are presented. To choose the right medicine, it is important to consider the age of the child:

1. Drops (Totem, Maltofer). Allowed to use from 16 weeks.
2. Syrups (Ferrum Lek, Aktiferrin). Designed for kids from 2 years old.
3. Tablets (Ferroplex from 3 years old, Tardiferon from 6 years old, Heferon from 12 years old).
4. Capsules (Aktiferrin). Assign to children older than 6 years.

Drops and solutions

The best option for the treatment of iron deficiency anemia in young children is the use of drops. Medicines are given with food and drinks. It is not recommended to add drops to tea or milk. Popular drugs in this group:

Syrups and suspensions

For children over 2 years old, syrups are suitable. Medicines are used in a course of 2-4 months until the iron level normalizes. Popular drugs:

Pills

This form of drugs is well absorbed, but not suitable for young children. Tablets that received a lot of positive reviews:

Did you find an error in the text?
Select it, press Ctrl + Enter and we'll fix it!

The drug maltofer contains iron in the most organic form. The child receives iron molecules almost identical in structure with mother's milk. The medicine is well absorbed by the body and does not cause allergies. Therefore, it is often prescribed to infants and even newborns for the treatment of anemia.

Indications for the use of maltofer for infants

Young mothers are well aware of the danger of iron deficiency for the baby when he is still in the womb. Gynecologists explain that this prevents nutrients from getting through the placenta to the fetus.

But we are little aware of why anemia is such a serious danger to infants. The quality of nutrition loses all meaning when there is not enough iron in the body. Iron molecules are a vehicle for nutrients. Enough transport - enough proteins, carbohydrates, vitamins and trace elements are absorbed by the body.

Low hemoglobin level - most of the substances necessary for the newborn are simply excreted. It is not clear how to ensure full growth and development in such conditions.

Maltofer is prescribed for babies in the following cases:

1. When diagnosing anemia through a special blood test.
2. Children at risk. These are premature babies and newborns on artificial feeding.
3. Too slow weight gain, varying degrees of dystrophy.

How to give maltofer to an infant

When the drug is prescribed and purchased, the question arises how to take it correctly. Even if the doctor has described in detail the way the baby takes the medicine, it is necessary to check the dosage. There is an instruction for this.

In infancy, when determining a single and daily dose, drugs are guided by weight, age and diagnosis. With iron deficiency anemia in full-term newborns, it is recommended to give 10-20 drops. It happens that anemia is not very pronounced and needs not treatment, but prevention of further development. Then 6-10 drops are recommended.

Accompanying premature babies requires a different dosage. They are given 1 drop per kilogram of weight for 5 months, regardless of weight gain and other parameters of growth and development.

The drug maltofer in syrup for children under one year is recommended to take - 2.5 - 5 ml. The dosage by months and weight is explained in detail by the instructions. In this case, the primary orientation of parents should be directed to the weight of the child, and not to age. If the weight of the child is small, and the norm is of concern, it is better to take a slightly smaller amount of medicine than the instruction suggests. Because the load on the kidneys and liver is designed specifically for weight.

Instructions for maltofer

Compound

The drug maltofer is a trivalent iron hydroxide. Additional substances depend on the form of release of the drug. So, the drops contain water, flavor, sucrose, sodium hydroxide, sodium methyl parahydroxybenzoate. Maltofer syrup has almost the same additives - plus a 70% sorbitol solution and 96% ethanol.

Release form

Babies are intended for two of the four forms of release: drops and syrup. Both forms are brown in color and have a sweetish creamy taste. The syrup is viscous in consistency, drops are not.

pharmachologic effect

Replenishes iron deficiency in the child's body during the period of active growth. Trivalent iron hydroxide is very similar in structure to the structure of natural ferritin. It is well absorbed by the body, without turning into an ionic form. The likelihood of allergies and side effects are reduced to a minimum.

Admission procedure

Maltofer should only be taken with or after meals. The daily dose is divided into several times, but you can give it at one time. Then it is best to do it in the morning.

You can dilute the medicine with water, fruit drink, juice. Can't make tea. Drinking maltofer tea is also undesirable.
Liquid dosage forms can be given to babies from birth. Tablets are intended for reception only from 12 years.

Duration of admission

The drug is taken for 3-5 months to treat anemia. To avoid subsequent latent anemia, the medicine should be taken for another 1-3 months. For infants, prophylactic administration of the drug is prescribed for as long as there is a need for increased iron consumption.

After leveling the hemoglobin in the blood and starting a good diet, maltofer can be canceled.

Side effects

Parents of infants note the first side effect shortly after the start of the drug. This is a change in the color of the stool. The instructions also warn about this, so you should not be scared. Maltofer will not stain the first teeth.

There are other side effects as well:

1. Paleness of the skin.
2. Diarrhea.
3. Constipation.
4. Vomit.
5. Discomfort in the abdomen.

Contraindications

Contraindications to the use of the drug in infants are:
Anemia unrelated to iron deficiency. Hypersensitivity to any component of the drug. Age less than 16 weeks.

Reviews of parents of infants on the use of maltofer

An overview of the most popular vitamin supplements for children from Garden of Life

How can Earth Mama products help new parents with their baby care?

Dong quai (Dong Quai) - an amazing plant that helps keep the female body young

Vitamin complexes, probiotics, omega-3 from the company Garden of Life, designed specifically for pregnant women

Positive reviews

Reviews of parents on the drug maltofer are generally positive. They note that the drug raises the level of hemoglobin in the blood of a child for a fairly short line. After a month, you can observe a positive trend, and after 2-3 blood counts completely return to normal.

Small drops of maltofer are not always liked, but the good thing is that the medicine can be diluted with any liquids. It can even be given with breast milk. Unlike bivalent iron preparations, the trivalent variant with milk is absorbed perfectly. This facilitates the process of giving the baby medication.

Parents note that there are side effects to the drug, but they can be adjusted with medications that relieve symptoms. For example, for constipation, Duphalac or other laxatives are used in parallel, etc.

The positive point is that allergic reactions to this medicine in babies of the first year of life are extremely rare. Mothers of children prone to various manifestations of allergies claim that their babies responded well to the drug. Allergy did not appear.

The medicine works better with the right regimen. Children need to be outdoors as often as possible. The room where the baby lives must be ventilated all the time.

Negative Feedback

Instructions not clear enough and not detailed enough. Mothers are at a loss how to give medicine to an infant, whether breast milk can be used, whether it is necessary to take vitamin C while taking the drug. The presence of side effects. Despite promises, the drops still stain the teeth. There are even cases when the first teeth of a baby appear already darkened. But after some time and after discontinuation of the drug, the normal color returns.

The high price of medicine.

How much does maltofer cost and in what form is it better to buy it

For a medicine in the form of a syrup and in the form of a drop, the price is approximately the same - within 300 rubles. It is much easier to give drops to an infant. Therefore, for the first dose, it is worth buying drops. 2.5 ml is half a teaspoon. If the child does not like the taste of the medicine, he will simply spit out the contents from his mouth. It is not so easy to spit out a few drops, and the high price of the drug will be justified by its full intake and positive result.

Is it possible to replace iron-containing drugs with products

The issue of replacing iron supplements with a balanced diet worries many parents. The main reason for this is the fear that the medicine will harm the child's body. Therefore, mothers and fathers often ask doctors if it is possible to get by with food and not take the drug?

Parents of babies diagnosed with latent anemia are especially persistent. It seems to them that stuffing a baby for the sake of several points of hemoglobin indicators is at least irrational, and at most harmful. Is it so?

In the case of a diagnosis of IDA (iron deficiency anemia), the answer is unambiguous - it is necessary to give the medicine. Babies in the first months of life intensively consume hemoglobin obtained in the womb. It has been proven that the fetus in the period from 7 to 9 months of pregnancy literally sucks iron from the mother. Therefore, many pregnant women have such a sharp decrease in blood counts in the last two months before childbirth.

But after birth, the child does not have such an opportunity. If there are signs of iron deficiency, it will no longer be possible to catch up with nutrition. Even if the mother feeds exclusively with breast milk and eats the same meat with buckwheat. The body needs help.

In premature babies, the situation is even more critical. They just don't have those two months of intense iron replenishment. Therefore, iron-containing preparations are essential for them. These babies are at risk.

Parents of children diagnosed with latent anemia and who doubt the need for medication should weigh the pros and cons.

High hemoglobin is not only and not so much weight gained on time. This is immunity, the ability to resist colds and the full development of the brain and nervous system.

The prophylactic dosage is not so intense and scary as to risk the health of the child and his full mental development. In addition, the price of the drug is ten times lower than the cost of the required therapeutic food package.

Hematologists have their own point of view on this matter. Practical results show that products can raise hemoglobin levels. But it happens very slowly. If you need to increase the level of iron effectively and in a short time, there is no alternative to the medicine.

For the full development and health of a child, a number of elements are vital. One of them is iron - a component of hemoglobin, which is contained in red blood cells and provides oxygen transport. Unfortunately, a fairly large percentage of children experience a lack of it, which often leads to anemia. The latter is a serious disease requiring medical treatment. The causes of deficiency are different: maternal anemia during pregnancy, failure to breastfeed, unbalanced diet, and others. In addition, the child may lack iron during periods of active growth or during intense physical exertion, including during sports. Iron-containing preparations for children will help to fill the lack of this element and cure anemia.

MEDICINES FOR THE TREATMENT OF ANEMIA AND GENERAL PRINCIPLES OF THEIR ADMINISTRATION

Iron preparations for the treatment of anemia in a child belong to the group of medicines. Therefore, only a doctor can prescribe them. He also determines the type of medication used, the duration of the course and, if necessary, corrects the treatment process. Giving these funds to a child on their own initiative is prohibited. Such drugs make up for the lack of iron in the body, thereby establishing the production of hemoglobin. There are a number of general principles for taking these drugs.

• You should not give your child iron preparations together with drugs that reduce the absorption of this element (levomycetin, tetracycline, antacids, etc.).
• For the prevention of dyspeptic disorders, often accompanying the course of treatment, with the permission of the doctor, it is possible to use enzyme preparations.
• The absorption of iron improves in the presence of certain vitamin complexes, so the course of treatment may include the simultaneous administration of ascorbic acid, vitamins B, B6, cobalt, copper, etc.
• Usually, doctors recommend giving children iron supplements between meals, because the salts and alkalis produced by the breakdown of certain foods can form insoluble compounds with this element, thereby preventing its absorption.

  TYPES OF IRON DRUGS

  Fast action. This group of drugs is drugs for intravenous or intramuscular injection. They are used in the treatment of severe cases of anemia, when it is necessary to raise the level of hemoglobin in the blood as quickly as possible. In addition, this group of drugs is used for chronic pathologies of the gastrointestinal tract that disrupt the absorption of iron in the intestine or for acute intolerance to oral complexes.

Prolonged action. This category includes oral preparations of various forms: tablets and capsules, mixtures, drops, etc. They are used in the treatment of moderate anemia. The course of treatment with the help of prolonged ferropreparations is longer in comparison with the injection, but it allows to achieve more stable and long-term results. The effect of oral medicines is usually observed approximately three weeks after the start of their use. Improvement in hemoglobin and an increase in the number of red blood cells occurs even later - within 2-3 months.

preventive action. This group of drugs is a dietary supplement that is not intended for the treatment of iron deficiency anemia. They are used either as an additional source of iron in the diet of healthy people, or as part of a complex therapy for iron deficiency conditions (along with ferropreparations and a special diet). In the latter case, before using dietary supplements, you should consult your doctor. The group of prophylactic agents also includes such a proven product as hematogen. One of its varieties is "FERROHEMATOGEN®-PHARMSTANDARD".

ABOUT THE PRODUCT

"FERROHEMATOGEN®-PHARMSTANDARD" is a dietary supplement made from albumin - processed blood of cattle. The composition of the product is designed in such a way as to optimize the absorption of iron, therefore it includes copper, ascorbic and folic acid, vitamin B6. "FERROHEMATOGEN®-PHARMSTANDARD" does not contain sweet additives - raisins, honey, chocolate, nuts, etc. Such ingredients not only increase the risk of allergies and make the product more high-calorie, but also negatively affect iron absorption. The use of bioadditives has a minimum of contraindications. These include hypersensitivity to the components of "FERROHEMATOGEN®-PHARMSTANDARD", high iron content in the body and diabetes.

For proper development, the child must receive a set of trace elements. One of them is iron. 2/3 of the iron that the body needs is in the blood (hemoglobin), the rest is in the muscles, bone marrow, liver and spleen. Fe atoms bind oxygen and transport it with the blood to the tissues, and carbon dioxide is taken from them. Iron is a vital element for humans.

Causes of iron deficiency in children

One of the causes of iron deficiency is malnutrition. Another reason is the wrong diet, lack of meat food. The child needs to receive at least 1 g of Fe daily. During active growth in children, iron deficiency increases.

List of causes of iron deficiency anemia (IDA):

Mothers of newborns should strive to breastfeed. Mother's milk supplies the baby's body with the necessary amount of iron.

Symptoms of iron deficiency anemia in a child

When parents notice that a child is eating dirt or chalk, they should take him to the doctor and examine the blood for Fe deficiency. Alarming symptoms are tearfulness, irascibility, unbalanced behavior, fatigue, weak muscles, pallor of the skin and the inner surface of the eyelids.

You should listen to the complaints of the child. Mom should be alert for the following signs:

• migrating pains in the region of the heart or throughout the body, cardiac arrhythmias;
• dizziness and headache;
• dry tongue and oral mucosa, loss of taste;
• belching and flatulence, problems with swallowing, discomfort in the stomach;
• poor memory, scattered attention, low learning ability, developmental delay;
• brittleness and thinning of nails.

A child with iron deficiency is cold all the time and has a low body temperature. His immune system is compromised, he is easily infected and often gets sick.

Diagnostic methods, norms of indicators in the blood

The presence of signs of iron deficiency is a reason to examine the child for a diagnosis. The main diagnostic method is a blood test.

The presence of a latent deficiency of Fe and IDA is indicated by the following indicators:

• hemoglobin content - less than 120 g/l (<110 - до 6 лет);
• color index (the ratio of the tripled amount of hemoglobin in g / l to the number of erythrocytes) - up to 0.86%;
• the concentration of ferritin (storing Fe atoms of proteins) is below 12 μg / l;
• serum Fe level - below 14 µmol/l;
• the saturation coefficient of transferrin (the protein that transports Fe) is up to 17%.

In addition, the total and latent serum iron-binding capacity (TIBC and LZHBC) is assessed. To identify the reserves of Fe in the body, a desferal test is performed - determining the amount of a trace element in the urine after an intramuscular injection of 500 mg of Desferal (with IDA - up to 0.4 mg).

To identify the source of anemia, gastric juice is examined for acidity, feces - for the presence of helminths and occult blood. The probability of blood loss is determined by counting the labeled 59Fe in the feces after intravenous injection. An x-ray examination of the gastrointestinal tract is also shown to detect tumors, hernias, ulcers and vascular pathology.

Rules for choosing iron-containing preparations for children, release forms

Preparations with Fe are not always easily absorbed by the child's body, may have contraindications and cause allergies. Which medicine to choose, the doctor decides. Therapy depends on the diagnosis and age of the child. The best iron tablets and drops are safe and palatable.

Babies under 3 years old are prescribed syrups, suspensions, drops, older children - tablets and capsules. If you need to quickly raise the level of hemoglobin, or taking pills causes vomiting and diarrhea, Ferrum Lek or sodium oxyferriscorbone for injection is administered intramuscularly, and iron saccharate (Venofer) is administered intravenously.

The best drugs for newborns and older children with iron deficiency

For young children, non-ionic Fe compounds are better suited - Ferlatum, Maltofer, Maltofer Fall, Ferrum Lek and t (we recommend reading: ).p. They have large molecules, they diffuse more difficultly through the intestinal mucosa, so an overdose is impossible. These drops and tablets react with food residues in the intestines and other drugs, which allows you to not change the diet and treatment regimens. These substances cause a minimum of side reactions characteristic of ionic (salt) compounds.

In case of early anemia in premature infants, the appointment of rhEPO (drugs of recombinant human erythropoietin) is indicated - Recormon, Eprex, Epokrin. Under their influence, the baby's body absorbs Fe better.

Recommendations for taking iron supplements in children of all ages

Iron preparations are prescribed individually. The optimal daily dose of Fe is 4-6 mg/kg, in the treatment of IDA - 5 mg/kg. The intestines of the child are not able to absorb a large dose.

Treatment is considered effective when reticulocytes (erythrocyte progenitor cells) double at the end of the first week. The increase in hemoglobin levels should reach 10 g / l weekly and return to normal after 3-5 weeks. The general course of treatment is 3 months, in order for the body to make reserves of Fe.

If during therapy the level of hemoglobin does not increase, then the diagnosis is made incorrectly, or a small dose of the drug is prescribed. In case of an overdose with an oral drug, it is necessary to wash the stomach, give the child milk or a raw egg to drink.

Recormon and other rhEPO are administered subcutaneously to infants. It is safer and more economical, because. requires a lower dose than intravenous injection. Injections are allowed to be done only in a hospital by experienced personnel.

It is necessary to observe how the child's body reacts to the medicine. The effectiveness of treatment is determined by the results of repeated tests.

Interactions with other drugs and vitamins

Preparations containing Fe may not be combined with other drugs, so you should warn the doctor about all the therapeutic regimens used. Iron has poor compatibility with calcium. It is not recommended to combine their preparations and food with calcium. Joint therapy with tetracyclines, enzyme drugs, chloramphenicol is contraindicated.

Carbonates, phosphates, zinc salts, antacids reduce iron absorption in the gastrointestinal tract. It is undesirable to combine non-steroidal anti-inflammatory drugs with anti-anemic drugs, because. this increases the irritating effect on the gastric mucosa.

List of the best vitamins with iron to prevent iron deficiency in children

In young children, the cause of anemia is usually a violation of the intestinal absorption of trace elements and vitamins. Therefore, IDA therapy should be supplemented with multivitamins.

In Russia, a line of children's vitamins Alfavit is produced for different ages with different Fe content:

• 1-3 years - Our baby (5 mg);
• 3-7 years - Kindergarten (10 mg);
• 7-11 years old - Schoolboy (12 mg).

Vitamins have an optimal composition that ensures good absorption and absorption of iron, taking into account incompatibility with calcium. They meet the necessary norms for the consumption of the element at different ages.

Contraindications and possible side effects

Antianemic agents should not be prescribed in the following cases:

• the diagnosis of IDA was not confirmed;
• the special nature of anemia (sideroahrestic, hemolytic);
• dystrophy, accompanied by the accumulation of ferritin in the tissues (hemosiderosis and hemochromatosis);
• blood cancer;
• infections caused by enterobacteria, Pseudomonas aeruginosa, Klebsiella.

Typical adverse reactions are nausea and vomiting, diarrhea or constipation, abdominal pain, poor appetite, flatulence, headache, metallic taste, tachycardia. Often there are manifestations of allergies - rashes, itching. When injected, redness and swelling occur. A severe case is anaphylactic shock.