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• Strange food cravings, such as eating dirt. • Not growing at the expected rate. “If you’re concerned your child may be anaemic, a blood test looking at haemoglobin and iron levels can be a good place to start,” she said. How to manage anaemia Ms McRae-Field says that for those trying to manage anaemia with diet, “you need to increase the amount of iron-rich food that you’re consuming”. Leafy green vegetables, lean red meats, nuts and seeds are among the food options she suggests for managing the condition. According to Ms Smallbone, good sources of iron also include pork, seafood, poultry and iron-fortified foods – for example, cereals and breads with added iron. But she warns that it’s important to pair iron-rich foods with foods that will help the body absorb this iron. “Having 100mg of vitamin C with an iron-rich meal can increase the absorption of iron \\\\\\\[from that meal\\\\\\\] by 67 per cent,” she said. “It makes sense to serve an iron-rich meal with some dark leafy greens, broccoli, capsicum or some citrus fruits like kiwi fruit or strawberries.” Ms Smallbone continued: “Children following a vegetarian/vegan diet or who may be fussy eaters may need some more assistance with iron supplementation in their diet.” While ensuring adequate iron-rich sources is important, Ms McRae-Field says it’s also important to be mindful of some of the dietary factors that can “prevent iron absorption”. She says these include “a poor diet – if your child consumes a lot of cow’s milk \\\\\\\[for example\\\\\\\] – and certain medications”. When it comes to causes of iron malabsorption, Ms Smallbone says children with possible gastrointestinal diseases may be prone to having low iron due to damage in the intestinal tract, leading to low absorption of iron, folate and vitamin B12. “Calcium rich foods like milk, cheese and yoghurts can be iron inhibitors, so they may be best enjoyed as a standalone snack,” she said. In terms of anaemia risk, “not enough vitamin B12 and folate can pose a problem”, Ms Donaldson says. Vitamin B12 is a water-soluble vitamin that is essential for healthy blood cells and neurological function. Low levels can cause anaemia. Good sources of B12 include liver, meat, milk, cheese and eggs – almost anything of animal origin. For those following a diet free of animal products (such as a vegan diet) it’s important to be aware of intake, due to this vitamin being predominately found in, and most easily absorbed from, animal products. Folate can be found naturally in green leafy vegetables, fruit (eg, strawberries, oranges and bananas) and legumes (chickpeas, beans and lentils) as well as being added to some foods, such as cereal products and fruit juices. Ms McRae-Field says that while many products are available in pharmacy that can help treat anaemia, these are not usually recommended until a diagnosis has been made by the GP. “Generally, the doctor makes their own recommendation of product and dosage, etc.,” she said. “The key things pharmacy assistants should know when working with parents whose children have anaemia is that anaemia is easily treatable.” Ms Smallbone says “a variety of brands” target anaemia in children, and their products are available in retail pharmacy, but it’s “important to read the label”. “The iron supplement market will have a variety of strengths available because children’s needs are different,” she said. “Many come with added vitamin C, activated B vitamins, vitamin D and multivitamins to assist absorption, energy and growth. “There are also iron supplements found in the ‘pharmacy medicine’ schedule in pharmacies. These lines are stronger and need to be given under the strict supervision of the child’s doctor with a dosing guide, so the parent will need these items on a prescription, for safe, accurate dosing. Ms Smallbone cautions that iron can be dangerous when dosed incorrectly in infants and young children, so correct dosing is essential. Ms Donaldson also offered a note of caution in terms of the role of vitamins, minerals and supplements. “Vitamin and mineral supplements can be helpful for those with an inadequate diet, but a consultation with a GP and dietitian should always come first,” she LITTLE LEGENDS 75 said. “A blood test will indicate if there’s an urgent need for supplementation. Inappropriate intake of supplements can be harmful if not required.” Role of a pharmacy assistant “The key things pharmacy assistants should know when working with parents whose children have anaemia is that anaemia is easily treatable,” Ms McRae- Field said. “However, it should only be treated with medication under the doctor’s recommendation.” She adds that pharmacy assistants need to remember that “lifestyle changes – for example, diet change – can help with the treatment of anaemia, but if uncertain, it’s best to refer \\\\\\\[the customer\\\\\\\] to the pharmacist”. Ms Smallbone advises pharmacy assistants to become “familiar with your pharmacy’s \\\\\\\[iron supplement\\\\\\\] range so you can help the parent make an informed decision about what to purchase”. “Important factors include the flavour, size of the dose required, and any additional vitamins and minerals that are incorporated with the formula,” she said, adding that educating customers about dietary recommendations will provide parents with valuable information “so they can incorporate iron-rich foods and food pairing effectively to get the best outcome for their children”. “Iron supplement education modules are available across all pharmacy training platforms and will give you and your team more confidence and knowledge when recommending supplements,” Ms Smallbone said. “But remember, when in doubt, always refer to the pharmacist to consult the parent of an anaemic child or \\\\\\\[child with\\\\\\\] suspected iron deficiency.” Ms Donaldson said: “Pharmacy assistants seeing parents and kids who are concerned about anaemia should encourage them to speak to their local GP to undertake further testing, as anaemia highlights that there’s another health issue occurring. We would also encourage them to see their local accredited practising dietitian, who can help them optimise their diet to prevent future deficiency from occurring. “For those taking iron supplements, a common side effect is constipation. Encouraging the consumption of plenty of water and eating foods high in fibre, such as fruit, vegetables and wholegrains, can help manage this.” RETAIL PHARMACY ASSISTANTS • APR 2021