Managing anemia in low-income toddlers: barriers, challenges and context in primary care

Area of Science:

• Pediatrics
• Public Health
• Hematology

Background:

• Iron-deficiency anemia is a significant health concern for low-income toddlers in the U.S.
• Anemia prevalence and management in high-risk urban pediatric populations require further investigation.

Purpose of the Study:

• To describe primary care providers' approaches to anemia in 1- to 3-year-old children in an urban ambulatory setting.
• To identify barriers and facilitators in the prevention and treatment of iron-deficiency anemia in this vulnerable population.

Main Methods:

• Retrospective review of 264 medical records of children aged 12-36 months.
• Semi-structured interviews with 41 clinicians serving high-risk children.

Main Results:

• 38% of children presented with anemia (Hgb < 11.0 g/dl) at least once.
• Only half of anemic children received treatment, with variable treatment cut-points.
• Follow-up labs were completed within 35 days for only 16% of treated children (median: 3 months).
• Key themes identified: iron-deficiency, communication, poverty, and system barriers impacting prevention and treatment.

Conclusions:

• Providers are clinically comfortable managing anemia but face significant burdens with follow-up.
• Communication and systemic issues are major barriers to effective anemia treatment and follow-up in low-income toddlers.
• Addressing these barriers is crucial for improving anemia management outcomes in pediatric primary care.