Q: My son is 1 year and 4 months old. His Hb is 8.4. I give him 1 drop of Ferium as prescribed by the doctor. But he gets acute diarrhoea after taking this and he had to hospitalised. Please advise.

A:Iron deficiency is probably the most common cause of anaemia in children aged 1-5 years. It is due to inadequate nutritional iron and/or the effects of chronic parasitic infections. The common dietary reasons for this are introduction of cows milk in the first year - cows milk has a lower quantity of poorly absorbed iron than breast milk; exclusive breast feeding beyond 6 months - although an excellent source of absorbable iron, breast milk on its own may not suffice to support the extra iron needs related to growth during the second six months of life; and excessive reliance on milks or other fluids in the second year of life. Iron in foods comes in two forms heme-iron (meat, poultry, fish) and non-heme or inorganic iron (vegetable source). Heme iron is better absorbed and non-heme iron is dependent on other factors for absorption such as ascorbic acid, meat, fish, and poultry. Inhibitors of iron absorption include bran, vegetable fiber, tannic acid found in tea, and phosphates. Most infants diets are deficient in heme-iron and are therefore dependent on supplementation to guarantee adequate dietary iron. Dietary treatment is always the mainstay, based on increased consumption of iron-rich foods, particularly highly absorbable haem iron sources, (meat, chicken and fish). In the first six months, ensure that any milk formula consumed is iron-fortified. If your son is on a purely vegetarian diet, the most absorbable sources of non-haem iron are legumes (the pea and bean family) and grains & green leafy vegetables to a lesser extent. If the child can take fruit juice along with the meal, that enhances non-haem iron absorption. The weaning should be onto iron-fortified cereal or formula. Your son should not drink more than about 3 glasses of milk daily so that he has an adequate appetite for iron-containing foods as milk doesn't contain any iron. At least four important variables may influence the success of treatment of iron deficiency anaemia with oral iron drops/syrup: the dose per 24 hours, the frequency at which the dose is provided, the form in which the dose is provided, and the patients adherence to treatment. The present criterion standard for treatment is 1.5 to 2.0 mg of elemental iron per kilogram of body weight provided 3 times per day (total dose: 4.5-6.0 mg/kg/d). The recommendation is to provide therapy for 2 months, then for 1-2 months more to replenish iron stores. The syrup or drops have a strong and unpleasant taste and may stain teeth if the drops are not placed carefully at the back of the infants mouth or the teeth are not immediately wiped or mouth rinsed properly. If the teeth become stained, the stain can be brushed off with baking soda. Studies have shown that administering iron in full dose even once a day gives adequate response and improves parental adherence to treatment. It can occasionally cause an upset stomach and should be taken with food to prevent this. Mix the iron medicine with a juice containing Vitamin C (orange juice, for example). This will improve iron absorption and prevent staining of the teeth. The iron may change the colour of stools to greenish black, but this is harmless.