Childhood Diseases

Question
Posted by: tlee | 2011-11-08

Q.

Follow-up to iron supplement queries

Dear Dr

You recently answered my queries re my 31 month old son''s immunity and iron supplements.

You recommended that we have a blood test which came back showing slightly anaemic and a low haemoglobin (10.9) so you suggested we test his stool for blood which we did (along with parasites). The results were all negative, incl. Rota Virus, Adena virus and all parasites and Microscopy. The only finding was " Fecal Human Heamoglobin Present" .

Our paed has referred us to a Pediatric Surgeon who we are seeing tomorrow to consider doing a scope up his bum (sorry note sure of the technical term) under anaesthetic to determine the cause of the blood in the stool.

We are quite certain that it is a cows milk protien allergy which he experienced when we weaned him from breastmilk to formula at 3 months (presented with a lot of visible blood in stool as well as cramping and bloating and digestive pain). He was fine on NAN HA and after 18 months we slowly introduced dairy with no obvious problems so we all (incl. paed) assumed he had outgrown the allergy.

He is a happy thriving boy above average height and weight (healthy weight though in line with his height) that eats a varied diet. It just seem that his immunity is very low and whenever he is around kids he just gets sick continually and can''t seem to shake anything without a long course of antibiotics and steroids. He barely lasts 3 or 4 days without getting another infection. We kept him out of playschool for 4 months (June - Oct) and supplemented 7.5ml Ferrimed daily as well as vitamins, zinplex and omega 3 but as soon as he was back at playschool the cycle started again.

Are we on the right track going to see the Surgeon and considering a scope? Does a cows milk protein allergy sound like a possibility to you (i have been told he is very young to present with this)?

If they cannot find the source of the bleeding with a scope what do we do next? Should we talk to the surgeon about testing his reticulocytes to see if they are low or is it not serious enough to do that yet?

Thanks again for your advice as we go through this. We do have great Doctors but it is always reassuring to have another perspective or confirmation that we are doing the right thing.




Expert's Reply

A.

Paediatrician

You are definitely correct, it is certainly possible that your son has a cow's milk protein intolerance. It would be worthwhile giving your son a completely milk/dairy free diet for at least one month. His stool should then be retested for blood. You will need a dietician's advice to achieve a safe milk free diet for your son. Only once you have tried this diet and if the bleeding is found to be persisting should your son have the scope done.

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