Jaundice

Jaundice

Jaundice is a yellow coloring of the eyes and skin. This yellow coloring is the result of a buildup of a chemical in the blood called bilirubin. It is a common symptom in newborn babies and is usually not a sign of serious illness. In older children, it can be a sign of a liver disease or a blood disorder.

Jaundice should not be confused with carotenemia, which is an orange- yellow coloring in the skin caused by too much carotene in the diet. Carotene is a natural food coloring found in fruits and vegetables that have a lot of Vitamin A. It is the natural chemical in plants that causes them to be yellow or orange. The easiest way to tell if a child has carotenemia instead of jaundice is to look at the white part of his eyes. If the child is jaundiced, the white part of the eyes will also be yellow, but with carotenemia, the white parts stay white. The bottom line is if the white part of your child's eyes look yellow, you should contact his pediatrician or family practitioner for an evaluation.

There are a lot of causes of excess bilirubin (hyperbilirubinemia) in the blood. If left untreated, most of the time the bilirubin with continue to increase slightly but will not reach dangerous levels. However, in some cases the bilirubin will continue to increase and can then act like a poison (toxin) to the nervous system, especially the brain. This is called kernicterus and can lead to deafness, seizures, or developmental delay. Fortunately kernicterus is rare because hyperbilirubinemia is usually easy to monitor and treat before dangerous blood levels are reached.

How does bilirubin get in the blood?

Bilirubin in a natural breakdown product of blood cells. Everyday, old red blood cells are destroyed and replaced with new ones. Each red blood cell lives about 120 days. Usually the rate of destruction and creation are in balance so that the amount of bilirubin from the destroyed blood cells is kept under control by the liver, which serves to clear bilirubin from the blood stream. Bilirubin is then taken up into the liver where it is converted (conjugated) to another form that is then excreted into the gut. This conjugated bilirubin is then broken down by bacteria and is what gives stool its brown to green coloring. Conjugated bilirubin can also be broken down again into an unconjugated form that reenters the blood stream.

If the body suddenly starts destroying red blood cells (a condition called hemolysis) faster than the liver can clear the bilirubin from the blood, the result can be hyperbilirubinemia and a yellow-orange coloring will be seen in the eyes and skin. Another way that bilirubin can accumulate in the body is if the liver is not working properly because of infection or some other condition and the conjugated bilirubin is not getting released into the intestine. This is called cholestasis. Again, the skin and eyes will get a yellow color, and sometimes the bowel movements with be white or clay colored instead of brown, green or yellow.

There are some simple blood tests that can help doctors tell these two types of hyperbilirubinemia apart. One blood test measures the total amount of bilirubin in the blood and the other measures the bilirubin that has been conjugated. The difference between these two measurements is used to calculate the unconjugated bilirubin. Another method used to measure total bilirubin in the blood uses a device held onto the skin and does not require a needle stick. The drawback to this method is that is can only be used as a screening tool and cannot replace the blood test in infants whose jaundice is getting worse.

In very young babies, jaundice is quite common. Most often the cause is physiologic, meaning it is not related to hemolysis or cholestasis, but rather to the slow transition of getting bilirubin cleared via the liver rather than the placenta once the baby is delivered. This type of jaundice usually first appears in the second or third day of life and peaks within the first week of life. The total level seldom reaches an amount worth getting concerned about or requiring treatment.

Other causes can be Breastfeeding jaundice or breast milk jaundice (see below). Breastfeeding jaundice and breast milk jaundice are two other types of hyperbilirubinemia in infants. Breast feeding jaundice describes the fact that breast-fed babies with physiologic jaundice generally reach higher levels of total bilirubin compared to formula-fed babies. There are many theories why this is the case, but regardless, even breast-fed babies with physiologic jaundice seldom get high enough levels of bilirubin to cause any problems. Breastmilk jaundice, on the other hand, usually appears during the second to third week of life and is believed to be caused by a hormone in breastmilk that interferes with the natural elimination of bilirubin. Some babies with breastmilk jaundice may get levels of bilirubin high enough to warrant treatment. Since it has been demonstrated that stopping breast-feeding for just twenty-four hours can dramatically decrease the level of bilirubin in the blood, some doctors advocate having the mother stop breast-feeding for a day if breastmilk jaundice is a concern. Others do not recommend this practice because they believe it causes mothers to quit breast-feeding too soon out of concern that there is "something wrong" with their milk.

Although most causes of jaundice in babies are benign and don't require treatment, newborns can also have hemolysis or cholestasis as a cause of their jaundice. For example, if the mother's blood is a different type than her baby's, she can pass antibodies against the baby's blood across the placenta to the baby. These antibodies can attack the baby's red blood cells and cause them to break down rapidly. Because there are many potential causes of jaundice in an infant, doctors pay close attention to newborns who show an excessive rise in bilirubin or a particularly lengthy course or if jaundice is found on the first day of life.

What are the treatments for jaundice?

Depending on the cause, the treatments may be fairly simple. In young infants with jaundice, the doctor will check the mother's blood type and the baby's blood type as well as a blood count to make sure that the jaundice is not related to hemolysis. She will also check both total and conjugated bilirubin in the baby's blood to determine if the cause could be related to cholestasis. If the blood tests are consistent with physiologic jaundice, the doctor may monitor the baby to see if the bilirubin levels are rising and may recommend that the baby get direct or indirect sunlight daily. If the bilirubin reaches a high enough level, the doctor may order that the baby be placed under special lights (phototherapy) to help bring down the level. But if the bilirubin continues to rise despite phototherapy, the baby may need a partial or complete blood exchange which is done in a hospital setting. This involves taking some of the baby's blood and replacing it with salt water (saline) or with someone else's blood (transfusion).

For patients with jaundice from cholestasis, treatment is aimed at the cause of the cholestasis. There is no danger of kernicterus in these patients, and they do not benefit from photo therapy. In fact, photo therapy in these patients can give them an odd bronze coloring (bronze baby syndrome) that takes a very long time to fade.

To learn more about specific causes of jaundice, please see the article about the specific disease or condition.

Diarrhea

Diarrhea is usually caused by a stomach virus, especially if it is also associated with vomiting and low grade fever. It is important to mention any recent travel to your doctor when your child has diarrhea.

Most uncomplicated cases go away on their own without treatment, except extra fluids to prevent dehydration, and testing for the specific cause of diarrhea is usually not necessary. Antidiarrheal medications should usually be avoided in children.

Common causes of acute diarrhea, lasting less than 14 days, include:

• Acute viral gastroenteritis is a very common problem in infants and children and is usually caused by a stomach virus, such as the rotavirus. Other common viruses that can cause diarrhea include the Norwalk virus and enteric adenovirus. Symptoms include a fever, stomach ache, vomiting and watery diarrhea. Although the vomiting typically lasts only two to three days, the diarrhea can last for one to two weeks before it finally resolves. There is no cure or medicine to treat gastroenteritis, but there are many things that can be done to help your child through this illness, including giving extra fluids to prevent dehydration. A rotavirus stool enzmye immunoassay test is available, and can help to diagnose children with rotavirus, which is sometimes helpful to make sure that they do not have another cause of diarrhea.
• Inflammatory acute diarrhea is usually caused by bacteria, which can cause dysentery, with bloody stools that are mucousy, fever, cramps and abdominal pain, and a loss of appetite. Bacteria that commonly cause diarrhea include Shigella, Escherichia coli (which can be associated with hemolytic uremic syndrome), Salmonella, Campylobacter, Yersinia entercolitica, Vibrio cholera and C. difficile (most common in children who have recently been on antibiotics). Examination of the stool can help to determine if diarrhea is caused by a bacterial infection if your child has symptoms of dysentery. Commonly performed tests include an examination for white blood cells or polys, which are commonly seen in bacterial infections, and rarely seen in viral gastroenteritis. An examination for blood and a culture may also be performed. Even though caused by a bacteria, not all of these types of infections should be treated with antibiotics. Shigella infections, or shigellosis are commonly treated with antibiotics, but other infections, including salmonellosis do not improve with antibiotics and treating children with this infection can actually cause then to be contagious for longer periods of time.
• Protozoal enteric gastroenteritis are caused by parasites, another common cause of acute diarrhea. Children with these infections typically have large amounts of watery diarrhea without blood, abdominal cramping, decreased appetite and weight loss. Common parasites that cause diarrhea include Giardia lamblia, which is usually spread from contaminated water supplies, especially streams, Cryptosporidium, which is commonly found in pets and farm animals and can be spread in day care settings, and Entamoeba histolytica, most common in travelers and immigrants to the US and which can cause bloody diarrhea. Treatment is usually with antiparasitic medications, including furazolidone and metronidazole (Flagyl). Testing of stool for ova and parasites (O&P) and Giardia antigen can help detect these infections.
• Food Poisoning: Almost any food can become contaminated by a virus, bacteria, or parasite and cause food poisoning. Foods can also make you sick if they are contaminated with pesticides or other toxins. The most common symptoms of food poisoning include vomiting, diarrhea, abdominal cramps, nausea and fever and they begin a short time after eating a contaminated food. In most people symptoms are mild and clear up quickly without treatment, but food poisoning can lead to dehydration, kidney failure and even death.
• Diarrhea is also a common side effect of taking antibiotics.

Persistent or chronic diarrhea is defined as diarrhea that lasts for more than two weeks. A referral to a Pediatric Gastroenterologist is sometimes necessary to evaluate children with chronic diarrhea, especially if the initial screening examinations are normal. In addition to infections, common causes of chronic diarrhea can include conditions that interfere with digestion or absorption, and include:

• Chronic gastroenteritis can be caused by infections, including those caused by viruses, bacteria and parasites. Most children with chronic diarrhea will have a stool test for polys and blood, a routine bacterial culture, an ova and parasite test, a test for the Giardia antigen and C. difficile toxin, especially if he has recently been on antibiotics.
• Postinfectious diarrhea sometimes occurs in children with gastroenteritis and may be from an intolerance to lactose or proteins in cow's milk. Soy milk or formula (for younger children) may be helpful for children with this condition.
• Toddler's Diarrhea or chronic nonspecific diarrhea usually occurs in children between the ages of 6 months and 3 years, and causes loose, watery stools in children without other symptoms. Although they have chronic diarrhea, children with toddler's diarrhea should have a normal appetite and will be growing and developing normally, and usually drink too much juice. If your doctor suspects that you child's diarrhea is from this condition, then it may help to decrease the amount of fluids your child drinks, and especially avoid juices with a high sorbital or fructose content, like apple and pear juice. Instead, give him orange and grape juice. It may also help to increase the amount of fat and fiber in his diet.
• Malabsorption can be caused by many different medical conditions, including cystic fibrosis, short bowel syndrome, celiac disease or gluten sensitive enteropathy and infections, especially Giardiasis. Children with malabsorption typically have very large and foul smelling stools, which may appear greasy, weight loss or poor weight gain and abdominal distention. An examination for stool fat content or a 72 hour stool collection for fat analysis, a test for carbohydrate by checking for reducing substances, and testing the stool pH may be helpful to see if a child has malabsorption. Children with malabsorption may also have a low serum albumin concentration. Other testing may include a small bowel biopsy.
• irritable bowel syndrome: Children with IBS have crampy abdominal pain and bowel movements that alternate between normal, constipation and diarrhea.
• Inflammatory bowel disease, including Ulcerative Colitis and Crohn's disease, with the most common symptoms being diarrhea, usually with bleeding, cramping abdominal pain, obstruction (a blockage of the intestine), malabsorption (failure of the intestines to absorb minerals and nutrients), and weight loss or poor weight gain. Other symptoms can include fever, anorexia (poor appetite), anemia (low blood counts), skin rashes, especially erythema nodosum (tender red bumps or nodules on the front of the lower legs) and pyoderma gangrenosum (painful skin ulcers), oral aphthous ulcers, and hepatitis (inflammation of the liver). Children with Crohn disease can also have perirectal disease, with fistulas, abscesses, or fissures around the rectum.
• lactose intolerance: diarrhea, abdominal pain, bloating, gas and weight loss can occur in children who don't have enough of the enzyme lactase to digest lactose in the foods they eat. While some children do have to avoid all products with lactose, others are able to handle some foods, such as yogurt, and other foods after taking a lactase enzyme supplement. See our guide to calcium requirements to make sure that your child is getting enough calcium if he isn't able to drink milk. Soy milk is a good alternative for children with lactose intolerance.
• Other causes of chronic diarrhea can include food intolerances, immune disorders, metabolic abnormalities, hormone secreting tumors, and other conditions that affect the pancreas, liver or small intestine.

Testing for chronic diarrhea can sometimes include a barium enema or other imaging studies, ileocolonoscopy, and biopsies, especially if the child has failure to thrive.

Chickenpox

Chickenpox is a highly contagious illness that should become much less a part of childhood as more children are given the Varivax vaccine. Chickenpox is caused by the varicella zoster virus and occurs most commonly in late winter or early spring. Unvaccinated children usually develop symptoms about ten to twenty-one days after being exposed to someone with chickenpox (incubation period).

Since the introduction of the chickenpox vaccine, cases of chickenpox in children have decreased almost 70-90%. The vaccine has also decreased the number of missed school days that children have.

Symptoms begin with a low grade fever, loss of appetite and decreased activity. About two days later, your child will develop an itchy rash consisting of small red bumps that start on the scalp, face and trunk and then spread to the arms and legs (but may also occur in the mouth and genitalia). The bumps then become blisters with clear and then cloudy fluid, and then become open sores and finally crust over within about twenty four hours, but your child will continue to get new bumps for about four more days.

All of the chickenpox lesions should be crusted over after about six days at which time your child will no longer be contagious. It may take another one to two weeks before all of the scabs finally heal. Once your child has had chickenpox he should have lifelong immunity.

There is no effective treatment for children who develop uncomplicated chickenpox, but if your child is given the Varivax vaccine within 72 hours of being exposed to someone with chickenpox, it may help prevent him from becoming infected. The only treatments are aimed at making your child more comfortable, and can include pain relievers, plenty of fluids, oatmeal baths, calamine lotion, and oral Benadryl for severe itchiness. Also keep your child's fingernails cut short and allow him to wear loose fitting clothing.

Treatment with acyclovir, an antiviral medication that can help to decrease the symptoms of chickenpox, should be considered for children at risk of developing a severe case of chickenpox. This includes children with pulmonary disorders, on steroid medications, or with immune system problems.

Another medication, Varicella Zoster Immune Globulin (VZIG), can be given as a preventative medication to children at high risk for developing a severe case of chickenpox as soon as they are exposed to someone with chickenpox (and within 96 hours) to help prevent them from getting infected. High risk children who are considered candidates for VZIG include those with immune system problems, pregnant women who have never had chickenpox and newborns whose mother developed chickenpox within 5 days before delivery or two days after delivery.

You should call your doctor if your child has chickenpox and the blisters become very red and tender, drain pus, if your child has high fever for more than 3-4 days or is unconsolable, has swollen and tender glands or if he is unable to drink and is becoming dehydrated.

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After having chickenpox, the chickenpox virus stays dormant in your body. In some children, it can become reactivated and cause shingles. The main symptoms of shingles is a rash on one side of the body that begins as a cluster of red bumps. These bumps then change into small blisters or vesicles that soon crust over. Your child may also feel itchy, but will otherwise be well. The rash usually continues to develop for a few days and then completely crust over and go away in about seven to ten days without treatment.

Children with shingles are contagious and can transmit chickenpox to others who aren't immune. Direct contact with the rash is necessary to be contagious, so he does not need to stay home from school if you can keep the rash completely covered.

Allergy Treatment Guide Allergic rhinitis, or hay fever, is a common problem in infants and children. The most common symptoms include a stuffy or runny nose with clear drainage, sneezing, itchy eyes and nose, sore throat, throat clearing and a cough that may be worse at night and in the morning. These symptoms usually occur during certain times of the year for people with seasonal allergies, corresponding to being exposed to outdoor allergens, such as tree pollens, grasses and weeds. Other people may have perennial allergies, with problems occurring year round from exposure to indoor allergens, such as dust mites, pets, second hand smoke and molds. Other signs of having allergic rhinitis include the 'allergic salute,' a common habit of children which consists of rubbing their nose upward. This is usually because the nose is itchy and this practice can lead to a small crease in the skin of the lower part of the nose. Children with allergic rhinitis also commonly have 'allergic shiners,' which are dark circles under the eyes caused by nasal congestion. Allergic rhinitis does run in certain families and are more common in children that have asthma or eczema. It is also more common in children that are exposed to second hand smoke, air pollution and pets. Having uncontrolled allergies can put your child at risk for getting a secondary sinus infection, ear infections, and for having poor concentration at school. It can also make asthma symptoms worse. Allergy Treatments The best treatment for allergic rhinitis is to avoid what your child is allergic to by following the prevention and environmental controls described below. Although food allergies as a trigger for a runny nose is not common, if you notice that your child's allergy symptoms always get worse after being exposed to certain foods, then you should avoid those foods. The most common foods that can cause problems include: milk, eggs (especially egg yolks), peanuts, soybeans, tree nuts, seafood, and wheat.

Allergy Prevention

These steps help to control common allergens, including dust mites, mold, animal dander and pollens. Get rid of dust collectors, including heavy drapes, upholstered furniture, & stuffed animals. Use an airtight, allergy-proof plastic cover on all mattresses, pillows and boxsprings. Wash all bedding and stuffed animals in hot water every 7-14 days. If you must keep pets in the house, at least keep them out of your child's bedroom and wash your pet each week to remove surface allergens. Avoid exposing your child to molds by keeping him away from damp basements or water-damaged areas of your home (check under carpets). Remove carpeting if possible. Vacuum frequently (when your child is not in the room, since many of the things that cause allergies are small enough to go back out of the vacuum cleaner bag). Cover air vents with filters. Avoid the use of ceiling fans. For seasonal allergies, keep windows closed in the car and home to avoid exposure to pollens and limit outdoor activities when pollen counts are highest (early morning for spring time tree pollens, afternoon and early evening for summer grasses, and in the middle of the day for ragweed in the fall) Consider using a HEPA filter to control airborne allergens (these only work if what you are allergic to is airborne, which doesn't include dust mites and mold). Keep indoor humidity low, since dust mites and mold increase in high humidity. Provide a smoke-free environment for your child (it is not enough to simply smoke outside).

Allergy Medications

The medications that are used to control the symptoms of allergic rhinitis include decongestants, antihistamines and steroids. If symptoms are mild, you can use over the counter medications as needed. Avoid using topical decongestants (such as Afrin) for more than 3-5 days at a time or frequent use of over the counter allergy medicines with antihistamines, as they can cause drowsiness and poor performance in school. Prescription allergy medications include the newer, non-sedating antihistamines, such as Allergra, Claritin, Clarinex and Zyrtec (usual dose is 1-2 teaspoons or 1 pill once a day), and topical steroids, such as Nasonex, Flonase, and Nasacort (usual dose is 1-2 squirts in each nostril once each day). If your child's symptoms are well controlled, then you can decrease the dose of the nasal steroid that you are using for 1-2 weeks and then consider trying your child off of it and see how they do. Continue the antihistamine for 1-2 months or until your child's allergy season is over. Keep in mind that Claritin is now over-the-counter and it is also available in the generic forms Alavert and loratadine. Singulair is another medicine for kids with allergies. Although previously just used as a preventative medication for kids with asthma, it is now also approved to treat allergies. It is available as a chewable tablet and is approved for kids over age 1. To be effective, your child should be using these medications every day. They will not work as well if just used on an as needed basis. They are in general very safe with few side effects, but the nasal steroids have been associated with growth suppression when used in high doses. This is however rare, and your pediatrician will monitor your child's growth to make sure this does not happen. If your child's symptoms are not improving with the combination of the antihistamine and steroid, then we may also use a decongestant, such as Sudafed, AH-CHEW D, or as a combination (Claritin D). For seasonal allergies, it is best to start using these medications just before your child's season begins and then continue the medicines every day all through the season. For perennial allergies, your child may need to take these medicines year round. Your child may also benefit from nasal irrigations using saline nose drops 1-3 times a day. This will help the sinuses drain.

Important Reminders

Call your pediatrician if you need a refill on your medications for allergic rhinitis, if your child is not improving in 1-2 weeks, or if he is showing signs of a secondary sinus infection, with a green runny nose lasting more than 10 days. If your child does not improve with these interventions, then we will consider having him see an allergy specialist for allergy testing to figure out what he is allergic to and to possibly start immunotherapy injections.

pediatric problem

Child Abuse

Child abuse is harm to, or neglect of, a child by another person, whether adult or child. Child abuse happens in all cultural, ethnic, and income groups. Child abuse can be physical, emotional - verbal, sexual or through neglect. Abuse may cause serious injury to the child and may even result in death.

Signs of possible abuse include:

Physical Abuse

• Unexplained or repeated injuries such as welts, bruises, or burns.
• Injuries that are in the shape of an object (belt buckle, electric cord, etc.)
• Injuries not likely to happen given the age or ability of the child. For example, broken bones in a child too young to walk or climb.
• Disagreement between the child's and the parent's explanation of the injury.
• Unreasonable explanation of the injury.
• Obvious neglect of the child (dirty, undernourished, inappropriate clothes for the weather, lack of medical or dental care).
• Fearful behavior.

Emotional - Verbal Abuse

• Aggressive or withdrawn behavior.
• Shying away from physical contact with parents or adults.
• Afraid to go home.

Sexual Abuse

• Child tells you he/she was sexually mistreated.
• Child has physical signs such as:
  • difficulty in walking or sitting.
  • stained or bloody underwear.
  • genital or rectal pain, itching, swelling, redness, or discharge
  • bruises or other injuries in the genital or rectal area.
• Child has behavioral and emotional signs such as:
  • difficulty eating or sleeping.
  • soiling or wetting pants or bed after being potty trained.
  • acting like a much younger child.
  • excessive crying or sadness.
  • withdrawing from activities and others.
  • talking about or acting out sexual acts beyond normal sex play for age.

Abuse can happen in any family, regardless of any special characteristics. However, in dealing with parents, be aware of characteristics of families in which abuse may be more likely:

• Families who are isolated and have no friends, relatives, church or other support systems.
• Parents who tell you they were abused as children.
• Families who are often in crisis (have money problems, move often).
• Parents who abuse drugs or alcohol.
• Parents who are very critical of their child.
• Parents who are very rigid in disciplining their child.
• Parents who show too much or too little concern for their child.
• Parents who feel they have a difficult child.
• Parents who are under a lot of stress.

If you suspect child abuse of any kind, you should:

• Take the child to a quiet, private area.
• Gently encourage the child to give you enough information to evaluate whether abuse may have occurred.
• Remain calm so as not to upset the child.
• If the child reveals the abuse, reassure him/her that you believe him/her, that he/she is right to tell you, and that he/she is not bad.
• Tell the child you are going to talk to persons who can help him/her.
• Return the child to the group (if appropriate).
• Record all information.
• Immediately report the suspected abuse to the proper local authorities. In most states, reporting suspected abuse is required by law.

If you employ other providers or accept volunteers to help you care for the children in your facility, you should check their background for a past history of child abuse or other criminal activity. Contact your local police department. Many states require that child care providers have background and criminal history checks.

Dealing with child abuse is emotionally difficult for a provider. As a child care provider, you should get training in recognizing and reporting child abuse before you are confronted with a suspected case. If you suspect a case of child abuse, you may need to seek support from your local health department, child support services department, or other sources within your area.

gizi anak

Anemia Gizi Anak Salah Satu Masalah Gizi Utama Di Indonesia
05 Aug 2005
Anemia gizi besi di masyarakat atau dikenal dengan kurang darah, merupakan salah satu masalah gizi utama di Indonesia yang dapat diderita oleh seluruh kelompok umur mulai bayi, balita, anak usia sekolah, remaja, dewasa dan lanjut usia. Berbagai kajian ilmiah menunjukkan bahwa penderita gizi buruk juga menderita kekurangan zat besi yang berdampak negatif terhadap pertumbuhan dan perkembangan anak. Secara klinis, anemia gizi dapat dikenali dengan adanya gejala 5 L yaitu lesu, lemah, letih, lelah dan lalai. Masalah anemia gizi dapat diketahui melalui pemeriksaan haemaglobin dalam darah. Demikian disampaikan Direktur Gizi Masyarakat Dr. Rachmi Untoro, MPH di Jakarta, 4 Agustus 2005 dalam pembukaan seminar sehari bertajuk Dampak Anemia Gizi Besi Terhadap Kecerdasan Anak. Acara ini berlangsung dalam rangkaian peringatan Hari Anak Nasional (HAN) 2005. Menurut Dr. Rachmi Untoro, anemia gizi merupakan masalah yang harus ditanggulangi bersama dengan dukungan kemitraan Lintas Program dan Lintas Sektor terkait, selain itu juga keterlibatan pihak Swasta, LSM, tokoh masyarakat dan tokoh agama. Oleh karena itu dalam rangka HAN 2005 kita bersama berharap dapat meningkatkan kerjasama dan kemitraan dari berbagai pihak terkait agar anak-anak kita tumbuh menjadi generasi penerus bangsa yang berkualitas. Berdasarkan Survei Kesehatan Rumah Tangga tahun 2001, prevalensi anemia pada balita 0-5 tahun sekitar 47%, anak usia sekolah dan remaja sekitar 26,5% dan Wanita Usia Subur (WUS) berkisar 40%. Sementara survei di DKI Jakarta tahun 2004 menunjukkan angka prevalensi anemia pada balita sebesar 26,5% dan pada ibu hamil 43,5%. Melihat beberapa hasil survei ini, anemia gizi masih merupakan masalah gizi utama pada anak-anak, ibu hamil dan wanita pada umumnya. Jenis dan besaran masalah gizi di Indonesia tahun 2001 – 2003 menunjukkan 2 juta ibu hamil menderita anemia gizi, 350 ribu berat bayi lahir rendah setiap tahun, 5 juta balita gizi kurang, 8,1 juta anak dan 3,5 juta remaja dan wanita usia subur menderita anemia gizi besi, 11 juta anak pendek, dan 30 juta kelompok usia produktif Kurang Energi Kronis. Anemia gizi besi disebabkan oleh hubungan timbak balik antara kecukupan intake gizi terutama zat besi dan protein dengan infeksi penyakit terutama kecacingan. Maka penanggulangannya adalah dengan memberikan suplementasi zat besi berupa tablet tambah darah dan penanggulangan kecacingan. Dampak yang ditimbulkan anemia gizi pada anak adalah kesakitan dan kematian meningkat, pertumbuhan fisik, perkembangan otak, motorik, mental dan kecerdasan terhambat, daya tangkap belajar menurun, pertumbuhan dan kesegaran fisik menurun serta interaksi sosial kurang. Keadaan ini tentu memprihatinkan bila menimpa anak-anak Indonesia yang nantinya akan menjadi penerus pembangunan. Oleh karenanya, seluruh komponen bangsa (pemerintah, legislatif, swasta dan masyarakat) bertanggung jawab memenuhi hak-hak anak yaitu kelangsungan hidup, pertumbuhan dan perkembangan serta perlindungan demi kepentingan terbaik anak sebagaimana termaktub dalam UU No. 23 Tahun 2002 tentang Perlindungan Anak. Sementara itu kebutuhan dasar anak untuk tumbuh dan berkembang meliputi pemenuhan kasih sayang dan perlindungan, makanan bergizi seimbang (sejak lahir sampai 6 bulan hanya ASI saja, 6 bulan – 2 tahun ASI ditambah makanan pendamping ASI). Selain itu, anak-anak juga perlu imunisasi dan suplementasi kapsul vitamin A, pendidikan dan pengasuhan, perawatan kesehatan dan pencegahan kecacatan dan cedera serta lingkungan yang sehat dan aman. Dalam acara seminar sehari ini hadir pula para pembicara pakar diantaranya Prof. Dr. Sutaryo dari IDAI membahas Prospek Intervensi Gizi Mikro pada Pertumbuhan dan Perkembangan Anak, Dr. Adi Sasongko dari Yayasan Kusuma Buana mengangkat topik Penangulangan Anemia Berbasis Sekolah Dasar, dan perwakilan dari Dinkes DKI Jakarta yang memaparkan Status Anemia Gizi Murid SD / MI Di Lima Wilayah Kota di DKI Jakarta.