Low hemoglobin in toddler despite supplementation

[Marnica]

My son is 2 years old. He first had his hemoglobin tested at 9 months old via a finger test in the office and it was low and the ped suggested floradix 1 tsp/day. He has been on this since then and his levels have not really gone up. He was seen this past weekend and his level was 10.8 via finger stick. He had it tested via venipuncture when he had his lead test at 18 months and it was 11.1 I think, which is "low normal". I know the finger stick is not all that accurate, but the ped is saying that she wants to retest in 3 months and if his levels are still low, than she wants to test for thalessemia (genetic disorder).

Now I did what I always do, reseach like crazy. What I have read is that if levels do not respond to supplementation within a few months, than further testing needs to be done like a serum ferritin level, and other various tests that would be more accurate than just looking at hemoglobin. Since he has been low and on floradix for a year and there is really no improvement, I'm thinking 3 more months isn't going to make a difference. Hemochromatosis also runs in my family (mother has it) and although this results in too much iron, I know from my research that hemoglobin levels are not an accurate reflection of iron stored in the body. In fact 73% of people with hemochromatosis have low or normal hemoglobin levels. I was also thinking perhaps he is not absorbing enough and perhaps ferrochel would be better absorbed or that he simply is not getting a high enough dose.
I have a call in to discuss with her why given his lack of response to floradix, she is not wanting to do further testing now. Anyone have any experience with low hemoglobin in their kids that did not respond to supplementation??

I do worry about this however, due to our family history and he is very pale, bruises easily and has weak fingernails.

[kjbrown92]

Isn't anemia one of the side effects of celiac? Have they tested for occult blood in stool to see if he's got blood in his stool?

[heathergirl67]

Does your ped know about your family history of hemochromatosis? I'm sorry, I don't have any experience in this area. I just wanted to offer support and say that I hope everything works out for you and your little boy!

[Marnica]

Originally Posted by kjbrown92

Isn't anemia one of the side effects of celiac? Have they tested for occult blood in stool to see if he's got blood in his stool?

No occult blood stool test, but we have already done celiac testing. He is gluten intolerant, but does not have celiacs. he has been off gluten since we got the test results (enterolab).

[Marnica]

Originally Posted by heathergirl67

Does your ped know about your family history of hemochromatosis? I'm sorry, I don't have any experience in this area. I just wanted to offer support and say that I hope everything works out for you and your little boy!

Not sure, I would think I told her, but I will double check if she ever bothers to return my call! Thanks for your support.

[sbgrace]

You need a complete count--including ferritin.

How much iron is in a tsp of floradix? I'm looking and it looks like 5 mg? If I'm right that's actually below his RDA (it's 11 mg. for up to a year and 7 mg. over a year to I think three if I remember right) for the past year. He needs well over the RDA to correct iron deficiency. So unless I misunderstood the amounts I think the issue is he's not getting enough iron to maintain let alone increase.

Given the family history, though, they need to look into the ferritin. More likely he's low because he doesn't have enough iron. That was the case with my son. Beyond that floradix didn't improve my son. Ferrous bis-glycinate (ferrochel is a brand name) is absorbed 3 x's better than other iron supplements without side effects. That's what finally got my son improved and did it fast. In your son you'd do at least 15 mg. per day of ferrous bis-glycinate (and vitamin C) and I'd probably do 20 mg. given how long he's been low and his age. If you stick with floradix do more than that. I get ferrous bis-glycinate via kirkman labs (hypoallergenic capsules--I think it's biomax line--check what iron a they sell more than one kind). Solgar gentle iron is also this type and is more available but it's in 25 mg. capsules. I dump iron on a spoon of pears and put pears on top. It could be dissolved in orange juice too. Maxi iron (I think) is a liquid form--I've not used it but someone linked it to me once.

Look at some old posts of mine re: things to avoid with iron supplementation. You need to keep eggs well away from iron, keep calcium containing foods (greens, dairy, fortified foods) away, beans (soy, regular) away, and bright fruits like prunes, red grapes, etc. and their juices away. Keep other mineral supplements and vitamins also containing minerals (like multis) away from iron supplements. B vitamins are ok and even good with iron. Most vitamins won't interact it's minerals that are the issue. All those things that inhibit iron absorption be at least two and preferably three hours away in both directions. Egg (yolk and white) are major iron inhibitors--the worst of all above in studies. Keep eggs away from iron and go very easy on egg over-all or (preferable) eliminate from diet until he's got normal ferritin.

All of this is, of course, assuming he's not got hemochromatosis.

I'm thinking I might be misunderstanding the dosage on the floradix because I can't imagine a pediatrician wanting you to give him only 5 mg. per day and then suggesting genetic testing if he doesn't improve on that. No kid would improve on that...deficient to start or not. So if he's only taking a tsp. I think there was a miscommuncation or, if not, I'd strongly consider switching peds over this. If that was her recommendation she made a major mistake to your child's detriment and should have caught it herself rather than telling you to keep doing it and that she wanted more tests.

[Panserbjorne]

yup to the above post.

And sorry...how long has he been off gluten?

[Marnica]

Originally Posted by Panserbjørne

yup to the above post.

And sorry...how long has he been off gluten?

not long.....2 months maybe

[Panserbjorne]

as much as I agree that he needs more supplementation I wouldn't have expected the issue to resolve that quickly on the heels of gluten ingestion if there is a verified issue. Sorry!

[Marnica]

Originally Posted by sbgrace

You need a complete count--including ferritin.

How much iron is in a tsp of floradix? I'm looking and it looks like 5 mg? If I'm right that's actually below his RDA (it's 11 mg. for up to a year and 7 mg. over a year to I think three if I remember right) for the past year. He needs well over the RDA to correct iron deficiency. So unless I misunderstood the amounts I think the issue is he's not getting enough iron to maintain let alone increase.

Given the family history, though, they need to look into the ferritin. More likely he's low because he doesn't have enough iron. That was the case with my son. Beyond that floradix didn't improve my son. Ferrous bis-glycinate (ferrochel is a brand name) is absorbed 3 x's better than other iron supplements without side effects. That's what finally got my son improved and did it fast. In your son you'd do at least 15 mg. per day of ferrous bis-glycinate (and vitamin C) and I'd probably do 20 mg. given how long he's been low and his age. If you stick with floradix do more than that. I get ferrous bis-glycinate via kirkman labs (hypoallergenic capsules--I think it's biomax line--check what iron a they sell more than one kind). Solgar gentle iron is also this type and is more available but it's in 25 mg. capsules. I dump iron on a spoon of pears and put pears on top. It could be dissolved in orange juice too. Maxi iron (I think) is a liquid form--I've not used it but someone linked it to me once.

Look at some old posts of mine re: things to avoid with iron supplementation. You need to keep eggs well away from iron, keep calcium containing foods (greens, dairy, fortified foods) away, beans (soy, regular) away, and bright fruits like prunes, red grapes, etc. and their juices away. Keep other mineral supplements and vitamins also containing minerals (like multis) away from iron supplements. B vitamins are ok and even good with iron. Most vitamins won't interact it's minerals that are the issue. All those things that inhibit iron absorption be at least two and preferably three hours away in both directions. Egg (yolk and white) are major iron inhibitors--the worst of all above in studies. Keep eggs away from iron and go very easy on egg over-all or (preferable) eliminate from diet until he's got normal ferritin.

All of this is, of course, assuming he's not got hemochromatosis.

I'm thinking I might be misunderstanding the dosage on the floradix because I can't imagine a pediatrician wanting you to give him only 5 mg. per day and then suggesting genetic testing if he doesn't improve on that. No kid would improve on that...deficient to start or not. So if he's only taking a tsp. I think there was a miscommuncation or, if not, I'd strongly consider switching peds over this. If that was her recommendation she made a major mistake to your child's detriment and should have caught it herself rather than telling you to keep doing it and that she wanted more tests.

I am going to go ahead and order the ferrochel, regardless of what she says The ped has not called me back. I am pretty pissed off actually. There was no miscommunication. She told me repeatedly 1 tsp of the floradix. I blame myself for not researching this earlier. I research EVERYTHING to death, but somehow I dropped the ball here. I really want to kick myself in the butt .
When she does call me back I have alot of questions I expect answers for. I am going to also demand a serum ferritin, serum iron and TIBC test. He will be getting some blood taken for the alcat test soon, so i figure he can get the iron stuff done at the same visit so he won't have to get jabbed twice.
As for this ped, she is one of the few that do not hassle parents about vaccinating around here. (I do not vax my son). I have already switched for that reason and I like her alot for many other reasons so switching wouldn't be very easy.
I talked to my mom last night and she said that the hemocromatosis she thijnks was aquired and not genetic, but she is not sure. It was so long ago, she can't remember. She seems to think I had the gentic testing back then and tested negative, but again she can't remeber for sure. I agree this is most likely a case of anemia and he is not getting enough to correct the problem.

[sbgrace]

That was a huge mistake by your ped. and I think she needs to know it as I'd assume she's giving the same bad advice to others. She must not know what's in floradix. Maybe she's thinking give them half the recommended for adults or something? I also think maybe that dose works for some kids because those same kids might be eating tons of supplemental iron in fortified cereals/breads/etc. All the iron added to foods is ferrochel by the way. So maybe other kids don't struggle because they are getting a lot elsewhere. It's not enough to correct deficiency by itself at any rate and she needs to know that.

I'm glad you're switching to the bis-glycinate. Get vitamin C to go with it too. I give it first thing in the morning so I only have to watch things that interfere for a few hours. I forgot (nut/seed allergy here) but nuts and seeds are an iron inhibitor too. You can do higher than 20 mg. if you'd like to fix it faster. Andrew went on low for a very long time as our doctor messed up too. I finally figured it out and we fixed the level very quickly with the bis-glycinate and avoiding eggs and the like. Let me know if you have questions.

[Marnica]

Thanks to all.
I think that's exactly what she thought in terms of dosage just do half the adult dose.

I'm still waiting for that call. I expect to be making my second call tomorrow because I haven't heard from her.

[blackbird2]

Hi,

my DS is about the same age, and we've been supplementing with iron for almost a year. (He was testing around 10 or 11). It took a few different types of iron before we found one that worked, so don't be discouraged if the first supplement is not effective (I sure was!). Ferric ammonium citrate (intergrative therapeutics, inc liquid iron with folic acid and b12) is working for us - yay! 10mg, which with this product is half a teaspoon.

Good luck!

[noobmom]

The finger stick is a screening test ONLY and you shouldn't be making any decisions based on it, except maybe the decision to get proper test with a blood draw.

I would be careful about taking too much iron. With the borderline hemoglobin numbers (low normal) you're talking about I'd not supplement at all and/or get the blood draw test done first. Why not just try to increase dietary iron at this point? I would be very hesitant to give a iron supplement based on a finger prick number.

Thalassemia trait runs in my family. It tends to occur in certain races (south Asian, Mediterranean, African, etc.) Perhaps you fall into one of those categories? My hemoglobin is always low and it's not correctable by taking iron. In fact, taking iron supplements can result in iron overload in people with thalassemia. My DS tested low (with the blood draw) and my ped had me put him on a supplement while we waited a month to see the hematologist. DS had his ferritin levels measured and they were at the absolute maximum of the normal range. The hematologist told me to never give DS an iron supplement again and to ignore any peds/family doctors who wanted to test his hemaglobin with a finger prick.

[Marnica]

Well, I agree that hemoglobin levels (without the serum iron and serun ferritin levels) is not the sole info to go on in terms of supplementing althgough i know that this is done all the time. The ped did call back 2 days ago and she told me she wanted to keep it at the same dose (5mg floradix) and not increase it and to wait 3 months because DS had grown x amount in y time. I do what i always do when I talk to docs without my notes in front of me - have a total brain fart - So I said fine, but I did order the ferrochel as I feel it may be better absorbed. I also didn't remind her of the hemochromatosis issue . But after some more thinking this just isn't sitting right with me.
DS will be getting some blood taken for the alcat test (allergy related and through our ND) so it would be no big deal to throw in a ferritin/serum iron test at the same time. I have called her again and she is not in today but hopefully will call me tomorrow. Hopefully she will agree. If she doesn't, Im just going to ask the ND to order it along with the alcat. I'm pretty sure he will.

noobmom - We have tried increasing dietary iron. The only iron rich food DS likes is spinach and this wasn't cutting it. He is a pretty picky eater. FWIW DS did have a CBC at 18 months where he had a hemoglobin level that was consistent with the pervious finger sticks. But it was just hemoglobin and not ferritin or serum iron

[sbgrace]

Originally Posted by Marnica

noobmom - We have tried increasing dietary iron. The only iron rich food DS likes is spinach and this wasn't cutting it. He is a pretty picky eater. FWIW DS did have a CBC at 18 months where he had a hemoglobin level that was consistent with the pervious finger sticks. But it was just hemoglobin and not ferritin or serum iron

Spinach is high in oxalates--it's an iron inhibitor. Keep it away from iron. Most greens are high in oxalate, calcium, or both and inhibit iron. I put a list of stuff that inhibits. You want to get all that figured out because you need to improve him fast (it's hard on growing/developing kids to be low) and if you give inhibitors with the iron you'll cut the absorption significantly--in some cases/some foods almost completely. I know in the past I've posted the (published, scientific research to support the list of foods I gave as inhibitors. I learned it all the hard way with my son. Remember, egg is an issue. That one often surprises people as does prunes/spinach/etc.