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Ds is anaemic again, who should monitor?

(39 Posts)
claw2 Mon 17-Feb-14 11:29:28

Ds has an extremely limited diet. He takes iron supplements, iron supplements stop once he isn't anaemic, he then becomes anaemic again.

At the moment it is left up to me to decide when I think he may be anaemic and request a blood test from my GP.

Should someone be monitoring, apart from me?

PolterGoose Mon 17-Feb-14 15:58:58

I don't know who you need to see. I assume he gets anaemic because of his restricted diet? Any reason why he can't take maybe a lower dose iron continually so he's not up and down, something like Floradix maybe?

Does he drink a lot of milk by any chance?

claw2 Mon 17-Feb-14 16:18:59

Hi Polter and thanks for reply, no he doesn't drink a lot of milk (banana milkshake occasionally) and yep due to restricted diet, I think (it was last time).

I took him to my GP a few months ago and asked exactly that question (as I didn't want to put him through another blood test) could he just take lower does iron supplement, as I thought it would be logical, that he would end up anaemic again in a bid to be pro active! they prescribed Fersamal 5ml a day. I also asked for vitamin supplements. My GP told me to buy some vitamins over the counter!

Ds keeps complaining of feeling sick, headaches, aching painful legs, finding it exhausting walking up stairs for example in school, not being able to concentrate etc. He isn't eating at all in school. Despite being on the lower iron, when ds was sent home from school recently I took him to my GP and asked for a blood test. He is anaemic again, as I feared.

I have a dr's appointment on Friday to 'discuss' blood count and prescribe medication. I would like to ask for a referral and for someone to monitor the situation. I think its unfair for me to have to decide when I think he may/may not be anaemic. Just unsure of who to ask for referral to.

lougle Mon 17-Feb-14 16:24:09

Unless it's severe or the cause is sinister, then it's a GP matter, Claw. Their advice to by some over the counter supplements is quite reasonable for mild-moderate anaemia.

What do you think should happen? I don't think it would be unreasonable for the plan to be that he takes supplements, weaning down as signs improve, then start again if signs of anaemia return.

PolterGoose Mon 17-Feb-14 16:25:08

Has he seen a dietician?

claw2 Mon 17-Feb-14 16:39:58

GP prescribed the iron supplement Lougle, it was the vitamins he said to buy over the counter. Over the counter iron supplement contain such low doses of iron, they do not help if you are anaemic. Too much iron if you are not anaemic is dangerous and can cause damage to internal organs, hence very low dose of iron in over the counter supplements.

Ds has been taking prescribed iron supplements for 3 months and is still anaemic. Previously he was severely anaemic, no iron and very low reserve. Not sure just how anaemic he is this time around, until Friday.

Usually ds is found to be anaemic, takes prescribed supplements for 3 months, no follow up. I would assume routine 3 monthly follow up for first year might be a good idea. However my GP looks at me as if im mad and makes comments such as 'im sure he will grow out of it'.

Ds has reoccurring anaemia caused by his diet, so ideally some help with the cause, improving his diet, I suppose and for someone to acknowledge that it is affecting his health and that he needs help with it.

claw2 Mon 17-Feb-14 16:42:35

He saw a dietician when he was about 3 and discharged, they said not their remit, as there is nothing physically stopping him from eating. Dieticians just tend to tell you what a kid should be eating, they are a bit stuck on what to do if a kid wont eat.

PolterGoose Mon 17-Feb-14 16:49:06

The dietician we saw didn't do that at all claw, we kept a food diary (specific brands and amounts) and she ran it through her computer programme to work out what he was lacking. She advised on some easy and maybe not so easy substitutions. It was useful to know precisely where his diet was deficient. It's hard to guess it because so many foods have hidden goodness smile

I'm still waiting to hear if the feeding clinic have accepted my ds's referral...

lougle Mon 17-Feb-14 16:54:50

What will he eat? What will he drink? How sensitive is he to drink flavour?

claw2 Mon 17-Feb-14 17:02:48

My GP doesn't seem to know where to refer ds to, which is why I usually have to be informed and ask for referrals.

Dietician might be a good starting point, as at least they should know where to refer to if they cant help.

Ds's diet is just so extreme, I shouldnt imagine he gets any goodness. His diet is slightly better at home, but still very restricted.

Ds did have some intervention from feeding clinic at his old school, however it was all counter productive as school didn't grasp the idea of the feeding plan and it failed. My GP doesn't grasp the whole eating thing either. When younger I think we must have gone full circle with referrals, however ds is now 10 and these were some time ago and im not happy for everyone to just give up on ds.

claw2 Mon 17-Feb-14 17:13:12

Daily diet consists of

breakfast - Cookie crisps, no milk (I can broaden this slightly to other sweet cereals)

Lunch - in school nothing to eat or drink (a few sips of water if lucky)
Lunch - at home, mini babybel cheese, dry bread (but not together, at separate times)

Dinner - 2 fish flippers (fish fingers shaped like a fish) chips

Snacks - salt and vinegar crisps, mini cheese, certain cakes and biscuits. Very occasionally raw carrot, peeled apple and grapes.

Drinks he will drink fresh apple juice, tropical fruit, blackcurrant. Water but in very small amounts. Occasionally banana milkshake.

He has tried other food ie a tiny little piece, but this tends to be to just please me and he never tries it again and it never becomes part of his diet.

I was thinking there must be a nutritional drink or something he could try. You know the kind they give to people who for whatever reason are not eating properly.

claw2 Mon 17-Feb-14 17:17:31

Drink flavour he really dislikes orange flavoured drinks. He can usually taste things added to drinks, although he is ok at taking tablets or sweet tasting medicines.

lougle Mon 17-Feb-14 17:21:41

So his recommended intake is 8mg/day

The Cookie Crisps will give him 2.59mg of iron (30g serving)

Would he attempt orange juice? Vitamin C increases iron uptake.

lougle Mon 17-Feb-14 17:22:12

x-post about the orange juice.

Tbh, most nutritional drinks taste fairly awful.

PolterGoose Mon 17-Feb-14 17:26:35

Which cakes and biscuits will he eat?

Do they have to be shop or home made?

What type/s of bread will he eat?

My ds has recently started having Innocent pineapple, banana and coconut smoothie, it's like a milkshake and alright it's high sugar it is packed full of goodies.

Does he have ketchup?

claw2 Mon 17-Feb-14 17:35:08

I would also like some advice on how I should be treating his anaemia. Things such as how often should I get it checked. How long does it take when not eating properly for iron levels and reserves to fall again etc, etc.

I don't know, some sort of plan rather than just leaving it up to me to monitor and decide when I think he needs a blood test.

Before when severely anaemic he showed no signs at all. What if I don't see the signs and it goes untreated. The feeling sick and headaches seems to be due to his eye disorder (which I have also asked for a referral) the painful legs when walking etc I put down to hypermobility, motor skills etc. Not being able to breathe, he has asthma. Although it might be due to being anaemic.

claw2 Mon 17-Feb-14 17:43:04

Bourbon biscuits and fairy cakes. He quite likes home made fairy cakes, I might get away with hiding something in there, but if he tastes it, it will put him off and he wont eat them again. It doesn't take much to turn him off foods.

He is fairly good with different types of bread ie crusty bread, pitta bread, etc. Variations in bread is quite successful! but no brown bread and no ketchup or sauces of any kind.

I think I would have more success of him accepting drinks, as long as he cannot taste what I have added.

claw2 Mon 17-Feb-14 17:44:22

Things rich in iron, which I can add to banana milkshakes or juice, might be an idea. Thanks Polter

claw2 Mon 17-Feb-14 17:46:15

I will be doing my shopping later, so any suggestions, more than welcome!

PolterGoose Mon 17-Feb-14 17:46:54

There's around 1mg iron in a slice of white bread

Best of Both (dietician recommended this for ds) has all his calcium needs for a day in 4 slices

I think you do need to start with dietician, you are so clued up now, and so assertive I'm sure you can push for proper assessment and follow up.

PolterGoose Mon 17-Feb-14 17:52:01

I would try Floradix and maybe start with a teeny amount in his milkshake very slowly building up to full dose. Although it may hide better in apple juice or blackcurrant?

You can make homemade ice cream with egg yolks and blitz this into milkshake (would make it like a MacDonalds one perhaps?)

Add an extra egg yolk when you make cakes.

Cook his fish things in a cast iron skillet, there will be some iron transferred apparently!

Can you swap bourbons for Oreos, higher cocoa content means more iron

claw2 Mon 17-Feb-14 18:09:51

Polter, I usually have all the answers for ds, his eating totally stumps me!

Over the years we have the done the rounds starting with dietician, then feeding clinic and OT input, then CAMHS feeding clinic. With CAMHS concluding 'sometimes you just have to accept this is as good as it gets'. We have followed all the recommendations, his diet has improved slightly at home, but he still refuses to eat in school. Sometimes, when stressed he will refuse to eat breakfast before school, I do treat it as very matter of fact, but it is worrying.

Where can i buy Floradix? I will give it a try and do some tasting myself and see what it mixes better with. I have been reluctant to hide things, as it has resulted in ds never touching something again.

Ds loves McDonalds banana shakes and homemade fairy cakes so that should be doable!

He doesn't like Oreos unfortunately

PolterGoose Mon 17-Feb-14 18:14:16

I used to get Floradix from local health food shop, I don't know why I stopped using it, me and ds used to have it confused or from Amazon

claw2 Mon 17-Feb-14 18:39:50

It would be sensible to ask for referral to dietician and tell her/him of any planned additional iron, so any changes to medication can be accounted for. I don't want to OD ds on iron (warnings on bottle prescribed by GP about keeping out of the reach of children as overdose can be fatal) and excess iron can be toxic to children

Similarly I don't want it to be a case of medication stops and ds gradually becomes anaemic again. We need a balance.

claw2 Mon 17-Feb-14 18:47:19

For me that is Polter, sorry it sounded like I meant for you!

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