title: Severe iron-deficiency anemia still an issue in toddlers.
abstract: OBJECTIVE
  Chronic, severe iron-deficiency anemia (IDA) in the first years of life increases the risk of irreversibly compromised cognitive, affective, and motor development. While IDA in infants has decreased because of dietary changes (iron-fortified formula and delaying cow's milk), toddlers (13-36 months) are equally vulnerable to the adverse effects of IDA. We aimed to show that despite public health efforts, severe IDA remains a problem in toddlers and is associated with excess milk consumption.
  
  
  METHODS
  Retrospective chart review of children 6 to 36 months admitted to or evaluated by hematology at a children's hospital from January 1, 2005 to December 31, 2010 with a severe microcytic anemia (hemoglobin [Hb] <9 g/dL and mean corpuscular volume (MCV) <75 fL).
  
  
  RESULTS
  We identified 68 infants and toddlers with severe IDA; most (84%) were 13 to 36 months old. The mean Hb and MCV were 6.0 g/dL (range = 2.2-8.9 g/dL) and 54.0 fL (range = 45.5-69.8 fL), respectively. Fatigue, poor appetite, and pica were the most common symptoms, found in 43%, 29%, and 22% of patients, respectively. Only 41% of parents reported pale skin while 77% of physicians recorded it on physical exam. Daily cow's milk consumption surpassed 24 ounces for 47 of 48 children with reported intake; 11 consumed more than 64 ounces per day.
  
  
  CONCLUSIONS
  Despite current screening recommendations, severe IDA continues to be a problem in toddlers and strongly correlates with excess cow's milk consumption. This reiterates the importance of screening for IDA into routine toddler care.
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Paoletti
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Bogen
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA kim.ritchey@chp.edu.
authors.forename: A Kim
authors.initials: AK
authors.lastname: Ritchey
mesh_terms: D000367:Age Factors; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D000818:Animals; D001066:Appetite; D002675:Child, Preschool; D004032:Diet; D004909:Erythrocyte Indices; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008892:Milk; D010842:Pica / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors
keywords: anemia; child; female; food habits; humans; infant; iron deficiency; male; milk; preschool; retrospective studies; toddler