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You are seeing a 16 month old toddler who is a very picky eater. He mostly eats 32 oz of whole milk per day, and a few finger foods. His parents feel that he looks pale – you check a hemoglobin and find that they are correct! It is 4.8 g/dL. He is active and playful, hemodynamically stable, and has no evidence of bleeding. He has no petechiae, purpura, hepatosplenomegaly, or mass, and the remainder of his blood counts (WBC, platelets) are normal.
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June 4, 2022 at 10:12 am
E) Begin iron therapy, counsel parents to reduce daily milk intake, and have follow up with pediatrician in 1 week
Iron deficiency anemia in toddlers fed a diet of predominant cow’s milk (as opposed to formula, breastfeeding, or foods) is commonly seen. Cow’s milk has low iron concentration and bioavailability, and cow’s milk protein may cause a proctocolitis with occult blood loss. Although the anemia can be severe on diagnosis, with very low hemoglobins, it develops gradually over a long period of time. Therefore, if the child is asymptomatic and not having gross bleeding, transfusion is not necessary. In classic cases, empiric oral iron and dietary counseling with close follow-up is the recommended management.