At first I thought our daughter, Anna, was eating ice because she was hot and bored. In North Carolina, we put ice in our drinks, and there can be a natural progression from using the ice to cool your drink, to eating the pieces that were left behind after you finish that last swallow. Kind of like a homemade slushy with chunks instead of shaves.
After a while I noticed her going to the fridge more and more often to fill a cup with crushed ice from the ice maker. Soon it seemed that every time I saw her she was crunching ice- at the kitchen table, in the living room, outside…
The habit was annoying, especially when she was unable to get the ice herself and she started calling me to bring it to her as if it were a drug she couldn’t live without. A cup of ice in the bathroom? I did a reality check and started to take notice. This was more than just a habit.
I briefly thought about it being OCD, but dismissed that thought quickly. I already knew that craving ice could be a sign of anemia, so I did a quick check of other signs and symptoms of anemia to see if this could be the cause. Hmmm. What were signs of anemia in children?
Eating Ice (Pica): Yes. While pica can include other non-food items, most people with iron deficiency choose ice. Fatigue and Loss of Energy: Yes, Anna had not been wanting to play as much recently, especially outside, but I had chalked that up to the heat of summer. Difficulty Concentrating: Sometimes. A symptom I attributed to her personality. People with spina bifida often have difficulty with ADD and organizational tasks. Shortness of Breath/Headache: Anna has a ventricular shunt, so we notice headaches. However, she recently had a revision surgery, so headaches wouldn’t have rung a bell for anemia. I did remember I’d seen her breathing funny during activities, but I thought she was dramatically trying to “get up the nerve” to do something by taking deep breaths. Dizziness: Hadn’t really noticed that. Pale Skin: Anna is very fair anyway, but pale skin was the other sign I had noticed that made me think there was more to the ice crunching than met the eye. She had been looking paler, with dark circles under her eyes. Leg Cramps: Anna had been complaining of leg cramps recently and we were concerned about the possibility of tethered cord. Almost a year ago her leg cramps were one of the symptoms that her spinal cord had tethered to the scar tissue around her spina bifida closure site. We did surgery, and many of the symptoms disappeared- including the leg pain. While a recent MRI showed all was still clear, she started having similar complaints of leg pain. I had been hoping the neurologist hadn’t missed something in the scan. Insomnia: Anna woke during the night almost every night. Several nights a week she would crawl into our bed in the middle of the night. After having four surgeries in less than a year, I wasn’t surprised she was having difficulty sleeping. Dry/Cracked Mouth: Anna’s mouth had been cracked in the corners, but we applied chap stick and discussed the importance of not licking your lips. Once again, another symptom I attributed to the heat and related summer activities.
All these signs prompted me to ask for a blood draw. At Anna’s well check last month I mentioned that I thought her iron was low. Doing a preliminary check of her palms, gums, and eyes, it was not readily apparent she was anemic. Had I not asked for her to be checked, the pediatrician would have never suggested it needed to be done. Fortunately, we have a great pediatrician who takes parent’s concerns seriously. He drew 3 vials and did complete bloodwork.
So how low does your iron have to be for you to start eating ice? Anna’s ferritin serum level was 8- low normal for her age/gender is 60. Her hemoglobin was 6 with low normal being 11. Her MCV (or measurement of the size of her her red blood cells) was 59 when it should be 77. Her iron saturation was 2% when it should have at least been 15%. These numbers are pretty low. Low enough that I would have expected to have “caught it” before now.
If you have a child with multiple health problems, you can easily miss signs and symptoms of anemia by attributing them to other causes. If your child is irritable from fatigue, you may even misdiagnosis them as simply having “bad behavior”.
Iron levels are so simple to check. If you see any of these symptoms, don’t wait until they become extreme. You can bring your iron levels back up, but it can take weeks, months, or even years (for some of my friends with celiac disease). Supplements don’t always absorb properly and can be yucky to take. The sooner you start, the shorter your journey back to good health.