For active and bubbly McKenna Hale, a typical day would start and end with a glass of milk. Her parents, much like many, never thought twice when she asked for a glass. It wasn’t until a whirlwind trip to the pediatrician, emergency room (ER) and hematology inpatient unit at Akron Children’s did they realize too much milk could cause anything other than healthy bones.
“You’re taught that milk is a healthy drink; it’s a great source of calcium,” said McKenna’s dad, A.J. Hale. “We thought it was great that she’d drink milk instead of juice or other sugary drinks. She had milk in the morning, maybe with a snack and at night. We never thought it was a problem.”
But, just before McKenna’s second birthday, she didn’t seem herself. After a near week-long fever and sporadic eating, McKenna’s parents took her to the pediatrician.
“I’ve been seeing McKenna since she was a newborn so I’m very familiar with her health and milestones,” said Katharine Wade, MD, pediatrician at Akron Children’s Hospital Pediatrics in Fairlawn. “She came in with a fever but had some other findings during the exam that were concerning. She had a new heart murmur and looked very pale.”
Since heart murmurs can be caused by a variety of things, including anemia, Dr. Wade ran a couple more tests to better understand McKenna’s condition. She sent blood work to Akron Children’s lab and told McKenna’s parents to take her to the ER for further evaluation.
Shortly after McKenna got to the ER, lab results confirmed her hemoglobin, a reflection of the red blood cell line, was low.
“Her hemoglobin in the office and from the lab was 4.7, normal for her age is 10.5-12.8. And her ferritin level, a measure of the body’s iron storage, was 2 and normal is 12-113,” said Dr. Wade.
The body needs iron to make hemoglobin. Hemoglobin is the protein in red blood cells that carries oxygen from the lungs and transports it throughout the body. When there isn’t enough iron in the blood stream, there isn’t enough hemoglobin to transport the oxygen that is needed throughout the body.
While the results of McKenna’s blood work was concerning, the good news was her white blood cells and platelets were normal which, if low, could indicate the presence of cancer. The bad news was McKenna had severe iron deficiency anemia. To treat it and restore normal levels of red blood cells and hemoglobin, McKenna needed a blood transfusion.
“Everything happened really fast. She received 1 unit of blood, which was given in 3 small portions…her fever broke after the first one,” said A.J. “The doctor (John Fargo, DO) doing the blood work was really fantastic with her. She wasn’t having fun, but he got her through it.”
Due to McKenna’s diet history and test results, doctors agreed that her high milk intake was the root cause of her anemia.
“Milk is very low in iron and the calcium found in it can actually decrease the body’s absorption of non-heme iron (iron from plant sources such as fruits, vegetables, grains and nuts) by as much as 50%, which can lead to iron deficiency,” said Dr. Wade.
In infants and preschoolers, iron deficiency anemia can cause developmental delays and behavioral disturbances, like decreased motor activity and problems with social interaction and paying attention.
“Toddlers, especially, are notoriously picky eaters. Often, if they drink too much milk, they’ll eat very little food at mealtime because they’re already full from the milk,” said Dr. Wade. “In general, I tell parents to limit milk intake to no more than 24 ounces a day. As long as a child is getting the appropriate servings of calcium in their diet, there is no daily minimum of milk that’s required; rather there’s a daily maximum to keep in mind.”
During McKenna’s time at the hospital, her parents talked to a nutritionist about changes she needed to make in her diet, including reducing milk intake and increasing iron-rich foods. She was also put on an iron supplement, which she takes twice a day.
“It was surprisingly easy to adjust McKenna’s diet,” said A.J. “We thought it would be a battle but she’s really been okay with it.”
In fact, at her recent 2-year well visit, Dr. Wade noted that mom said McKenna was eating much better and her behavior was better, too.
“It’s wonderful to see my patients grow and thrive and McKenna is doing just that,” added Dr. Wade.