any ideas why 4.5yo DS is anaemic?

[CappuccinoCarrie]

DS1 is 4 1/2, a very happy boy, developing brilliantly and very excited about starting school in September.
Today we were told he's anaemic, and starts iron supplements immediately, but I'm wondering why as I know anaemia is only a symptom, and something must be causing it.

A bit of background: he's always been tiny for his age, was born at 25th centile, dropped to 2nd by 5mo and has been down at the 2nd ever since. We took him to HV at 2yo as it seemed odd he was so small (DH and I are both 5ft 10 and have immediate relatives well over 6ft), and they weren't concerned at all as he was following his growth curve and developing brilliantly.
He's always been a child who's needed a lot of sleep, and although he eats a very balanced diet, he has a very small appetite, and for example if he has a big lunch, will often be too tired and not hungry enough for dinner and will go to bed on an empty stomach and still sleep through, and make up for it at breakfast. But other times he eats a normal evening meal.
Last autumn he had a skin infection, then a nail bed infection, both of which finally cleared up following a course of antibiotics. Then the skin infection suddenly came back before Easter, the GP prescribed anti-biotics and referred us to the hospital because she was concerned that it had come back. The infection was around his bottom, all external, but some fissures and bleeding too so GP was keen to get a specialist opinion. Saw a lovely paediatrician the following week (impressive NHS referral!) who did blood tests, stool sample etc and took a swab. It still showed signs of infection so she prescribed a longer course of stronger anti-biotics.
Today I had the blood results back, and he is anaemic. All other results were completely normal. I reiterated concern about his size/appetite/tiredness/inability to fight infection but she assured me that the coeliac results were negative. So if its not coeliacs, then what other reason could there be for his failure to absorb iron from food, and lack of growth?
FIL has coeliacs, and his first symptom was anaemia, which was diagnosed when he was a teenager.
Thank you if you're still reading, all ideas welcome including telling me I'm a neurotic mother!!

Is he failing to absorb iron? Or is he just not getting enough? Lots of kids are anaemic because they don't eat the right stuff.

If he has had lots of tests and all clear then I would try and stop worrying.

I have to admit to not knowing how much iron kids need, or whether or not he's getting enough! I think our diet is pretty balanced (although I know that doesn't necessarily equate to the right nutrients)
He has his 5 fruit and veg a day, we eat brocolli with pretty much every meal, red meat a couple of times a week, breakfast cereals which are fortified, and he's joined me in my pregnancy addiction to hard boiled eggs at lunchtime! But I'm happy to hear that he's not getting the right sort of iron and take advice on how to adjust his diet accordingly. I'd much rather he got his iron through diet than supplements.

you need vitamin c to aid absorption of iron

How did they rule out coeliac disease? Via a blood test or endoscopy? Have have CD & had similar symptoms pre diagnosis. I was also small, tired a d bit hungry as a child.

Did they say what his Hb level is?

The coeliac test was a blood test.
I think they said his level was 12.
Just been looking up high iron foods and he has most of them on a weekly (or daily) basis such as tuna, egg and peanut butter.
Maybe he's not getting enough vitamin C foods though...?

OMG the typos.

Should read - I have coeliac disease and had similar symptoms pre diagnosis. I was also small, tired and not hungry as a child...

Fortunately I understood exactly what you meant, don't worry! When were you diagnosed - as an adult or a child? Did you have any other symptoms that indicated coeliacs and did you catch up with growth?
It wouldn't have crossed my mind if FIL didn't have it, so I don't know if I'm seeing it just because the idea has been put into my head, or if its really there.
Going to bed now, will check back tomorrow.
Thank you for your time everyone :)

Do you give him milk to drink with his meals? The calcium in milk inhibits the body's uptake of iron. As louismummy said, you need vitamin c to improve the absorption of iron so maybe (if you don't already) give him watered - down orange juice with his meals. We're vegetarian so I have always been conscious about iron levels in my 3 DSs. Dried apricots are a very good source of iron as is a powdered chocolate drink called Milo (you can get it in big supermarkets). The cereal Grapenuts is also very high in iron. I give my boys Spatone, a natural liquid iron, a couple of times a week as it's very effective (I took it with all my pregnancies and despite being veggie I always had the Hb of a horse). Have you considered asking for a dietician referral?

Friends son was classed as "failure to thrive". Ended up seing an older consultant who suggested he have his tonsils out. Atfer that he was a different child, and flourished.

I was diagnosed as an adult but looking back it was there for years. I had issues with anaemia as a kid and took iron supplements for a while. I have never had any of the classic gastro symptoms. A bit of constipation as a child but assumed that was normal...but may be not, I don't know! I had lots of odd things viruses I couldn't shift etc as my immune system wasn't functioning properly.

My blood I was diagnosed as an adult but looking back it was there for years. I had issues with anaemia as a kid and took iron supplements for a while. I have never had any of the classic gastro symptoms. A bit of constipation as a child but assumed that was normal...but may be not, I don't know!

I didn't catch up with growth. I was always the smallest in the class & am still classed as petite. I barely are though really. The being too full and tired to have dinner I can really identity with. It's bloating but you don't know this as a child or that it's not normal!

My blood test has always been negative and I was diagnosed by an endo, which is the gold standard. As there is family history, it's worth getting in touch with coeliac uk. They are experts in getting the right tests and ruling it out for sure.

My phone has gone nuts, sorry

Thank you for the really feedback everyone!

He only had milk at breakfast, and water at all other meals. We've replaced that with diluted orange juice for at least one meal a day, and the only milk is on his cereal.

I will ask about seeing a dietician and make sure we're getting the best sort of iron into DS through his diet.

The tonsils is an interesting one - and one I hadn't thought of at all!

I'll reiterate the family history of coeliacs at the next appointment. I hope for all our sakes it isn't that, but if it is then we need it diagnosed sooner rather than later.

OP, bear in mind that coeliac is just a tip of a large iceberg and a result of built up damage to the gut. Wheat as well as dairy can prevent absorption of vits/minerals.
You say his other tests were normal, fair enough, but I bet you he was probably not tested for other deficiencies, like zinc or vit Bs.
After years of apparently normal tests my ds was found to be gluten intolerant and was borderline deficient in most nutrients esp aminoacids (proteins).
Ditch the cerals, make him a cooked breakfast instead, they need proteins/aminoacids to build their bodies, not carbs that only fuel insuline high. If he always seems hungry, that's b/c he is not getting the right nutrients so his body is wanting more nutrients but still not getting what it needs. Iron is best absorbed from animal protein, eg red meat. Supplements are ok as a temp help but good diet is crucial.
Read up more on gluten/wheat as it's linked to anaemia, failure to thrive, deficiencies and lots of other problems.

Hi Carrie, it's your Halifax buddy here. Hope you get somewhere when you book to see the GP again. What I learnt with L is that you need to be prepared to stamp your feet and fight for follow ups. I think if you don't get answers from your GP, coeliacs or otherwise, then you need to be pushing to see a paeds consult.

Saying he is anaemic and giving him iron supplements is fine short term, but unless it seems to sort the problem long term then you need to not be fobbed off. Sorry to sound so negative, it's just you know what a battle we had to get L the help she needed.

When L was at her worst I couldn't keep her awake through the day, couldn't get her out of bed in the morning, she stopped growing, constantly ill etc. According to the first 3 GPs we saw about her, she was fine, no problems .

Since we got a proper diagnosis from a specialist and some good advice from a dietician she has just flourished. Bottom line is that as lovely and gorgeous and bright as he is, if he is not growing, has a poor appetite, constant tiredness, is unable to fight infection then he is not okay. If he isn't okay then they need to help you get to the bottom of it, particularly so he can flourish at school.

Hope I don't sound too negative, I just want you to be prepared to have to push for help. I love your little DS and don't want you to be fobbed off like we were.

Also, if your gut instinct (no pun intended!) is that it could be Coeliacs then have a read through the NICE guidelines: publications.nice.org.uk/coeliac-disease-cg86/guidance
Point 1.1.18 says that if blood tests are negative but coeliac disease is still suspected then the GP ought to refer to specialist.

Damn it!

publications.nice.org.uk/coeliac-disease-cg86/guidance

Thank you everyone :)
nightcat we have more of an issue that he isn't hungry, tonight for example he ate his veg (slightly under duress) then left the whole of the rest of his dinner.
HalifaxB keep reminding me of that...
Its a paed consultant that we'll be having the follow up with, this time I'll go in more knowing what I want to say!
My fear is that the biopsy is such an invasive procedure, I'd have to be 100% sure myself before putting my little boy through that.
Still have no idea how this could be related to the skin infection/fissures?!
I'll follow that link now...

Interesting...DS1 fulfils 3 of the 7 criteria in the NICE guidelines.
Gulp.

My story is the same as *NothingLeft's.
*
I grew OK as a child but always a bit run down, contracted lots of tummy bugs. Anaemic on and off for 20+ years. Was finally diagnosed as coeliac age 40 after abrupt decline in health. My blood test is negative, I was diagnosed following an endoscopy.

I wouldn't rule it out unless they are offering another explanation.

Speaking from experience with my ds:

Gluten causes other deficiencies, eg zinc, aminoacids etc.
Zinc deficiency causes cracked skin and poor healing. Zinc deficiency also causes deficiency of numerous enzymes in the body.
Cracked skin leads to bacteria/fungal to colonise and cause infection (bum area is an easy target).
Gluten also affects immunity and makes it harder for body to fight off infections.

That's really helpful-the inability to fight infection was what took me to the dr in the first place. I'll ask what his other levels were in the blood (not entirely sure what they tested for!)

Always get copies of tests so you can have a close look yourself. I found that even though some of my ds results were deficient or borderline, overall they were still described as normal.

sent you a pm

Let me know how you get on Carrie, I hope you get somewhere with it. Talk soon XXxx