Preventing iron deficiency anaemia

The role of follow-on formulae

Many studies have indicated that iron deficiency is common in Britain. It is particularly prevalent in areas of social deprivation, typically inner cities and in children who are members of an ethnic minority group. In 1986 Ehrhardt showed that 28% of Asian children and 12% of Caucasian children admitted to hospital in Bradford were anaemic. A further study completed in 1990 in an inner city practice in Nottingham showed an overall incidence of anaemia of 25%, rising to 39% in Asian children.

The clinical consequences of iron deficiency anaemia are well documented. However, there is growing evidence to suggest that iron has a vital role to play beyond the red blood cell. The non-haematological effects of a lack of iron are not fully understood. Evidence from several studies would suggest that iron deficiency anaemia is associated with behavioural and cognitive changes. If these behavioural changes are related to tissue deficiency and not to haemoglobin concentration, they may be important before iron deficiency has been clinically detected.

The association of iron deficiency during infancy with changes in behavioural development has been shown in at least five independent studies conducted in five separate cultures. All five studies used careful definitions of iron status and included comparison groups without anaemia. All showed that infants with anaemia scored lower on tests of mental development than infants without anaemia; on average 6-14 points lower on the Bayley Scales of Infant Development. Four of the studies showed that anaemic infants’ scores on motor development tests were lower.

In intervention studies, anemic infants treated with iron did not show a significant improvement in the development tests after 1-2 weeks of iron therapy. The potential consequences of these findings have far reaching effects and the need to prevent iron deficiency in early infancy becomes a priority for the health professional. The use of appropriate weaning foods in conjunction with infant formula is widely recommended in the first year. Although the tendency for mothers to keep their infants on infant formula for longer is increasing, some mothers still change their infants to doorstep cow’s milk before the age of 12 months. The 1990 survey indicated that as many as 36% of infants were given cow’s milk as the main drink at nine to ten months. In addition, even if the older infant is maintained on infant formula, it is usual to find low intakes of milk as little as 300-400ml daily. This supplies less than 50% of the infant’s iron requirements. It seems reasonable, therefore, to encourage follow-on formula for infants over six months of age who are on low volumes of infant formula and those infants who have already changed to cow’s milk.

Unfortunately, most follow-on formula is not available on milk tokens, which severely limits its usage. Other than this, it does not appear to have any disadvantages over standard infant formula for infants over the age of six months, and there is little evidence of parents misusing it by giving it to babies below this age. As we concluded in our leader in last month’s Professional Care of Mother and Child, it is probably time to reappraise our thinking on follow-on formulas, as they may be one of the many resources we can use to help prevent iron deficiency.

Words:

Follow on formulae – дополнительные смеси

Token – ярлык, информация о составе

Caucasian: of a proposed human racial classification distinguished by light and brown skin colour and including peoples indigenous (native) to Europe, N. Africa, W. Asia and India.

Hemophilia