An important, commonly missed & easily treatable cause of poor school performance in Indian Children

This is a letter from Dr Yamuna, Academic and Behavioral Paediatrician at Vanavani Matriculation Higher Secondary School, IIT, Madras, discussing an important, commonly missed & easily treatable cause of poor school performance in Indian Children

"For the last two months I have been seeing students who are not studying well. 

Though Specific Learning Disability and ADHD have been the significant conditions preventing better performance, I have observed some important medical, physical and Social reasons for poor performance. 

Iron Deficiency:

Iron Deficiency not necessarily anemia, during preschool days is known to cause significant cognitive changes that can hamper comprehension and recollection. Serum Ferritin is the marker for stored iron, keeping in mind that it is also an acute phase reactant. 

I was taken aback to find readings as low as 1, 2 12 etc in children from families belonging to upper middle income. The children eat but do not eat right. Also Literature supports supplementation of Iron during this period of growth to prevent the IRON DEFICIENCY State in the children.Some children had hemoglobin between 11 & 12.g%, which is anemia by definition, but not addressed.

I felt that we as Paediatricians can make a difference to the academic performance of our children by just ensuring IRON SUFFICIENCY state during Preschool years. 

Secondly,  in the presence of Iron Deficiency, an increased level of Zinc Erythrocyte Protoporphyrin is detected and this can be used as a screening tool. 

 On a given day, the number of bottles of Iron containing medicines sold from any pharmacy is much much lesser than Multivitamin containing products. 

Can we start enhancing the storage Iron in our Preschoolers which might help in improving their scholastic ability. 

Thanks for helping me in sharing what I observed,

Sincerely,

Yamuna"

Comment: I would request all Pediatricians to consider doing a S Ferritin level in addition to Hemoglobin estimation for kids with behavioral & learning problems. Parents may ask their pediatrician for this test, as it is fairly easily available across the country and costs less than a thousand rupees in most places. Make sure that the child is NOT suffering from any acute infections while being tested, since that can raise the Ferritin levels even in children with iron deficiency.