Article Type : Review Article
Title :   Anaemia in Children: A Comprehensive Review of Burden, Etiology, Diagnosis, and Management
Authors :   Anubhuti Tidke
Abstract :   Anaemia in children remains a major global public health problem, particularly in developing countries. It adversely affects physical growth, cognitive development, immunity, and overall morbidity and mortality. Iron deficiency is the most common cause, although infections, nutritional deficiencies, genetic disorders, and chronic diseases also contribute significantly. According to the World Health Organization (WHO), nearly 40% of children under five years of age worldwide are anaemic. This review aims to provide a comprehensive overview of the epidemiology, etiology, pathophysiology, clinical features, diagnostic approach, prevention, and management of childhood anaemia. Understanding these aspects is essential for early identification, appropriate treatment, and effective public health interventions to reduce the burden of this preventable condition.
Introduction :   Anaemia is defined as a condition in which the hemoglobin concentration in blood is lower than the normal range for age and sex, resulting in reduced oxygen-carrying capacity of red blood cells 1. In children, anaemia is a significant nutritional and public health problem with long-term consequences on growth, development, and school performance. The World Health Organization defines anaemia in children aged 6–59 months as hemoglobin <11 g/dL.2 Globally, anaemia affects nearly 1.6 billion people, of whom a substantial proportion are children.3 Developing countries bear the highest burden due to widespread malnutrition, poverty, infections, and limited access to healthcare. In India, anaemia continues to be a major concern despite several national programs targeting nutritional deficiencies.4 Childhood anaemia not only increases susceptibility to infections but also leads to impaired cognitive and psychomotor development, poor academic performance, and reduced work capacity in adulthood.5
Review of Literature :  Methodology This review is based on a comprehensive literature search of electronic databases including PubMed, Google Scholar, WHO, UNICEF, and national health surveys such as the National Family Health Survey (NFHS). Keywords used included “anaemia in children,” “iron deficiency anaemia,” “pediatric anaemia,” “nutritional anaemia,” and “childhood malnutrition.” Articles published in English within the last 15 years were primarily included. Additional references were obtained from standard pediatric and hematology textbooks. Both observational studies, systematic reviews, and national guidelines were analyzed to summarize current evidence on childhood anaemia. Review of Literature 1. Epidemiology of Anaemia in Children Anaemia is highly prevalent among preschool and school-aged children worldwide. According to WHO estimates, approximately 42% of children under five years of age are anaemic globally. The prevalence is highest in South Asia and sub-Saharan Africa. In India, NFHS-5 (2019–21) reports that about 67% of children aged 6–59 months are anaemic. Socioeconomic status, maternal education, dietary habits, and access to healthcare significantly influence prevalence.6 2. Etiology of Childhood Anaemia7 The causes of anaemia in children are multifactorial and include: Nutritional deficiencies Iron deficiency (most common) Folate deficiency Vitamin B12 deficiency Protein-energy malnutrition Infections and infestations Malaria Hookworm infestation Tuberculosis Chronic inflammatory conditions Hemolytic anaemias Thalassemia Sickle cell disease Hereditary spherocytosis Bone marrow failure Aplastic anaemia Leukemia Chronic systemic diseases Chronic kidney disease Liver disease Iron deficiency anaemia (IDA) alone accounts for nearly 50–60% of all anaemia cases in children worldwide.
Discussion :  Pathophysiology8 Anaemia results from one or more of the following mechanisms: Decreased red blood cell production – due to iron, folate or vitamin B12 deficiency, bone marrow suppression. Increased red blood cell destruction – as seen in hemolytic anaemias. Blood loss – due to gastrointestinal bleeding, parasitic infestations, or menstruation in adolescents. Iron deficiency impairs hemoglobin synthesis, leading to microcytic hypochromic anaemia. Chronic infections cause anaemia of inflammation due to altered iron metabolism and reduced erythropoiesis. 4. Clinical Features9 The clinical presentation depends on the severity, duration, and underlying cause. Common symptoms include: Pallor Fatigue and weakness Irritability Poor appetite Breathlessness on exertion Frequent infections Poor growth and delayed milestones Severe anaemia may present with tachycardia, cardiac failure, and systolic murmurs. Iron deficiency may also cause pica, koilonychia, and glossitis. 5. Diagnosis10 Diagnosis is based on: Hemoglobin estimation – using automated analyzers or point-of-care devices. Peripheral blood smear – to assess RBC morphology. Red cell indices – MCV, MCH, MCHC. Serum ferritin, serum iron, TIBC – to differentiate iron deficiency from anemia of chronic disease. Reticulocyte count – to assess bone marrow response. Additional tests – Hb electrophoresis, vitamin B12 and folate levels, stool examination for parasites. 6. Classification of Anaemia3 Based on hemoglobin levels (WHO): Mild: Hb 10–10.9 g/dL Moderate: Hb 7–9.9 g/dL Severe: Hb <7 g/dL Morphological classification: Microcytic hypochromic Normocytic normochromic Macrocytic anaemia 7. Management of Anaemia in Children : Management depends on etiology and severity.5 Iron Deficiency Anaemia Oral iron therapy: 3–6 mg/kg/day of elemental iron Parenteral iron in cases of intolerance or poor absorption Treatment duration: 3 months after normalization of Hb Vitamin Deficiency Anaemia Folate supplementation: 1–5 mg/day Vitamin B12 injections as per standard protocols Severe Anaemia Packed red cell transfusion when Hb <5–6 g/dL with symptoms Treatment of Underlying Cause Deworming Anti-malarial therapy Management of chronic diseases 8. Prevention and Control6 Iron and folic acid supplementation programs Food fortification (iron-fortified cereals) Deworming programs Promotion of exclusive breastfeeding Timely complementary feeding Improvement in maternal nutrition School health programs and periodic screening In India, programs such as the Anemia Mukt Bharat (AMB) and National Iron Plus Initiative (NIPI) aim to reduce anaemia across all age groups. 9. Impact of Anaemia on Child Health7 Anaemia in early childhood has long-term adverse effects on: Cognitive development and IQ School performance Physical growth Immune function Economic productivity in adulthood Early diagnosis and correction are therefore crucial for national human resource development.
Conclusion :  Anaemia in children continues to be a significant public health challenge, particularly in low- and middle-income countries. Iron deficiency remains the most common etiological factor, but multiple nutritional, infectious, genetic, and chronic disease-related causes also contribute. Early recognition through routine screening, accurate diagnosis, and timely treatment are essential to prevent long-term complications. Strengthening nutritional programs, improving maternal health, ensuring food security, and enhancing public awareness are key strategies for effective control of childhood anaemia. A multifaceted approach involving healthcare providers, policymakers, and communities is required to achieve sustainable reduction in the burden of pediatric anaemia.
References :  
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