TODDLER IDA SCREENING

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• Design: Cross-sectional analysis of 1,735 healthy children aged 12–36 months, attending routine primary care visits in Canada OUCI+15ResearchGate+15Scribd+15.

• Goals:

  1. Examine how serum ferritin varies with age.

  2. Compare serum ferritin to hemoglobin for detecting iron deficiency.

  3. Assess prevalence of elevated CRP (a marker of inflammation) Journal of Pediatrics+2Scribd+2SciSpace+2OUCI+3ResearchGate+3Scribd+3.

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📉 Key Findings

• Age–Ferritin relationship:

  • Between 12–15 months, ferritin dropped by ~9% per month (95% CI: 5–13%) SciSpace+4ResearchGate+4Scribd+4.

  • From 15–24 months, it plateaued (no significant change).

  • After 24 months, it slowly increased (~2% per month) OUCI+10ResearchGate+10PubMed+10.

• Hemoglobin patterns:

  • Stable from 12–24 months and increased after 24 months (~20% per month) Scribd+1OUCI+1.

• Diagnostic Performance:

  • Using serum ferritin < 12 µg/L as the gold standard:

    • Hemoglobin < 110 g/L had only 25% sensitivity (i.e., missed 75% of iron-deficient children) but 89% specificity Journal of Pediatrics+15ResearchGate+15SciSpace+15.

  • Elevated CRP (≥10 mg/L) was rare (~3.3%) Muck Rack+15ResearchGate+15Scribd+15.

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✅ Conclusions & Clinical Implications

• Serum ferritin is a more sensitive test for early iron deficiency than hemoglobin.

• The ideal screening window appears to be around 15–18 months, when ferritin is at its lowest Muck Rack+14PubMed+14SciSpace+14ResearchGate.

• In low-risk children (without inflammation), adding CRP may not be necessary.

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🧭 Recommendations for Primary Care

1. Incorporate ferritin testing at ≈15–18 months during routine check-ups.

2. Use a cutoff of <12 µg/L to flag iron deficiency.

3. Continue hemoglobin screening at 12 months (per Canadian/AAP guidelines), but recognize its limitations.

4. Reserve CRP testing for cases with suspected inflammation.

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NS

Here’s why humans

really evolved stamina

18May,p11

FromHowardBobry,

PortTownsend,Washington,US

The idea that humans evolved

endurance and stamina to chase

prey might have it backwards. Prior

to the development of sharp tools,

we were ill-equipped to consume

prey animals, lacking, as we were,

the teeth and claws of a carnivore.

Our early ancestors were gatherers,

not hunters. It was us who were the

prey, and our survival depended

upon our ability to outrun notthe

predator, but ourfellow humans.

If you and I, out gathering, were

approached by a lion, I wouldn’t

need to outrun the lion to survive,

only you. Survival ofthe fittest

atits most basic level!

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