A 4-year-old male child is observed to have anaemia. A history of picky eating is obtained from the mother. Which of the following deficiencies is likely in this child?

Appeared in: RML 2023

Explanation

Iron deficiency is the most common nutritional disorder in the world and the most frequent cause of anemia in toddlers and young children.
The clinical history of a 4-year-old being a 'picky eater' strongly points towards a diet low in iron-rich foods and potentially high in cow's milk, which is a primary risk factor.
Unlike other nutritional anemias, iron deficiency is extremely prevalent in this specific age group due to a combination of rapid growth and selective dietary habits.

Option A: Vitamin B12 deficiency is uncommon in this age group from simple picky eating. It causes megaloblastic anemia, not the microcytic anemia typical of iron deficiency.
Option B: While Vitamin C aids iron absorption, its deficiency is not a primary cause of anemia. Severe Vitamin C deficiency results in scurvy, which has a different clinical presentation (e.g., bleeding gums, joint pain).
Option D: Folic acid deficiency also causes megaloblastic anemia and is much less common than iron deficiency in picky-eating toddlers.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Nutritional deficiencies causing anemia in children as background academic context rather than a clinical decision trigger.
Nurses play a crucial role in anticipatory guidance, educating parents of toddlers about healthy eating habits to prevent iron deficiency.
Screening for anemia is a standard part of pediatric well-child visits, and a dietary history is a key component of the assessment.
Patient education on administering iron supplements is vital for compliance and effectiveness, including tips to enhance absorption (with Vitamin C) and manage side effects (like constipation).

How to Approach the Question

First, identify the key elements in the clinical scenario: a 4-year-old child (toddler/preschool age), anemia, and a history of picky eating.
Recall the most common causes of nutritional anemia in this specific pediatric age group.
Correlate the history of 'picky eating' with the most likely dietary insufficiency. This behavior often involves high intake of milk and low intake of meats and vegetables.
Evaluate each option based on its prevalence and typical cause. Iron deficiency is the most common nutritional deficiency globally and is particularly high in this demographic.
Rule out the other options by considering their specific risk factors (e.g., vegan diet for B12, goat's milk for folate), which are less common than general picky eating.
Select the option that represents the most common and statistically probable diagnosis given the patient's age and history.

Concept Tested & Keywords

Concept Tested: Nutritional deficiencies causing anemia in children.
Stem keywords: 4-year-old, anaemia, picky eating
Lead-in keywords: likely
Clinical cues: Age (4-year-old): This age falls within the toddler/preschool period, a peak time for developing iron deficiency due to dietary habits.
Clinical cues: History (picky eating): This is a classic risk factor for inadequate intake of essential nutrients, particularly iron.

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E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 657-659

E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 2 (pp 239-476 of 713) p. 124-126

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 111-113

Practise the full RML 2023

Attempt every question from this paper in a timed mock, then review the full solution for each one.