Anaemia in Children (Low Blood): Paleness, Tiredness, Eating Mud, Causes, Iron-Rich Diet and Bala Pandu in Ayurveda

🌐 Read this article in other languages:
ગુજરાતી: બાળકોમાં એનિમિયા (લોહીની ઉણપ): ફિક્કાશ, થાક, માટી ખાવી, કારણ, આયર્નયુક્ત આહાર અને આયુર્વેદમાં બાળ પાંડુ
हिंदी: बच्चों में एनीमिया (ख़ून की कमी): पीलापन, थकान, मिट्टी खाना, कारण, आयरन युक्त आहार और आयुर्वेद में बाल पांडु

Six-year-old Janaki was sluggish at school and tired quickly while playing; her teacher said “she doesn’t pay attention.” At home she had a poor appetite and irritability, and one day her mother saw her licking mud off the wall. Her face and nails were pale, and the inside of the lower eyelid was white. Janaki drank three glasses of milk a day, but ate little dal and vegetables; sometimes she had itching around the anus at night. Tests showed hemoglobin 8.2, very low ferritin and worms in the stool. The pediatrician gave worm treatment and iron syrup (three months); milk was reduced to two cups a day, with jaggery and chana, green vegetables, amla, cooking in an iron kadhai, and no tea with meals; along with Ayurvedic agni deepana and gentle support as advised by the vaidya. In three months her hemoglobin was 11.8, and Janaki was running, laughing and studying again.

Anaemia means that the hemoglobin in the blood, the protein in red blood cells that carries oxygen to the whole body, is lower than normal for age. According to WHO, below 11 g/dL in children from 6 months to 5 years, below 11.5 at 5–11 years, and below 12 at 12–14 years is considered anaemia. According to national surveys in India, more than half of children under five have anaemia, and the most common cause is iron deficiency. Anaemia is not just tiredness; it affects brain development, learning ability, immunity and growth, which is why the government runs the “Anaemia Mukt Bharat” programme. In Ayurveda it is called pandu roga, “pandu” meaning a pale, yellowish-white colour, and in children Charaka has specially described mridbhakshanajanya pandu (pandu caused by eating mud); at the root are agnimandya, depletion of rasa and rakta dhatu and disturbance of pitta (ranjaka pitta, which gives blood its colour).

Symptoms

• Pale skin, lips, nails, inner surface of the eyelids, palms
• Tiredness, weakness, getting breathless quickly while playing
• Poor appetite
• Irritability, lack of attention, falling behind in studies
• Craving to eat mud, chalk, ice, wall plaster, paper (pica)
• Frequent infections
• Headache, dizziness (in older children)
• Fast heartbeat
• Brittle, spoon-shaped nails (in the long term)
• Smooth tongue, cracks at the corners of the mouth
• Hair fall
• Slow growth and development
• Cold hands and feet
• In severe anaemia, swelling, breathlessness, strain on the heart: hospital

Mild anaemia often has no clear symptoms, so regular testing is useful in children at risk.

Causes

Iron deficiency (most common)

• Complementary food after 6 months started late or low in iron, only milk for a long time
• Too much cow’s milk, milk is low in iron, reduces iron absorption and kills appetite; cow’s milk as the main drink before 1 year can also cause a little blood loss from the intestines
• Periods of rapid growth, 6 months to 2 years, and adolescence
• Menstruation in adolescent girls
• Premature birth, low birth weight, low iron stores at birth
• Mother’s anaemia in pregnancy
• Cutting the cord immediately at birth, delayed cord clamping gives the baby more iron
• Iron from a vegetarian diet is absorbed less, when not taken with vitamin C
• Tea or coffee with meals, reduces iron absorption
• Junk food

Blood loss

• Worms such as hookworm, suck blood from the intestines
• Frequent nosebleeds, heavy periods (adolescent girls)
• Hidden blood loss from the intestines

Other causes

• Vitamin B12 and folate deficiency (especially in strictly vegetarian families)
• Malaria, chronic infections
• Celiac disease, absorption problems
• Thalassemia, sickle cell and other inherited blood disorders, more common in some communities in Gujarat and India
• G6PD deficiency
• Kidney disease, lead poisoning

Important: in thalassemia trait (minor), hemoglobin is slightly low but there is no iron deficiency; giving iron there brings no benefit and causes harm in the long term. So testing is needed before starting iron, especially when there is no improvement despite treatment.

Ayurvedic view

• Mridbhakshana (eating mud), counted by Charaka as a separate type of pandu; in modern terms, eating mud is both a symptom of iron deficiency and a cause of worm infection.
• Agnimandya, food does not reach rasa and rakta.
• Excess kshara, amla, lavana, ushna food, viruddha ahara.
• Krimi.
• Divaswapna, lack of exercise (kapha).
• Raktasrava (bleeding).
• Stanya dushti, the mother’s nutrition.

Ayurvedic Understanding

Charaka described five types of pandu roga: vataja, pittaja, kaphaja, sannipataja and mridbhakshanaja. Pandu is considered mainly a pitta-predominant disease: vitiated pitta vitiates rakta and makes the skin colour pandu (pale); along with this, rakta, mamsa and meda dhatus become depleted, the body becomes “nihsara” (without essence), and ojas decreases. Among the symptoms, Charaka described tiredness, weakness, breathlessness, loss of appetite, palpitations, heaviness of the body, irritability and sleepiness, which show remarkable similarity with modern anaemia.

About mridbhakshanaja pandu, Charaka says that eating mud, according to the qualities of the mud, aggravates the doshas, blocks the rasavaha srotas, destroys agni and causes krimi; in treatment the very first step is breaking the habit of eating mud, followed by shodhana and giving strength. Tradition mentions mixing bitter herbs with mud to break the habit of eating it.

In Ayurveda, loha-containing (iron-containing) formulations, mandura (purified iron rust) and loha bhasma, are widely used in pandu treatment, which fits beautifully with modern iron treatment; but in children dose and purity are extremely important.

Samprapti: inadequate or unsuitable food, mridbhakshana, krimi, agnimandya → disturbance of (ranjaka) pitta, depletion of rasa and rakta dhatu → pandu colour, daurbalya (weakness), ojas kshaya.

Samprapti vighatana: nidana parivarjana (mud, worms, wrong diet) → agni deepana → (mild shodhana if needed) → loha (iron) supplementation → blood-building food → rasayana → increase of ojas.

Classical References

• Charaka Samhita, Chikitsa Sthana, Chapter 16, Pandu Roga Chikitsa (including mridbhakshanaja pandu).
• Sushruta Samhita, Uttara Tantra, Chapter 44, Pandu Roga Pratishedha.
• Ashtanga Hridaya, Nidana Sthana, Chapter 13 and Chikitsa Sthana, Chapter 16, Pandu.
• Charaka Samhita, Sutra Sthana, Chapter 24, Vidhishonitiya: pure blood.

Tests

• CBC, hemoglobin, MCV (red cell size), RDW, red cell count
• Ferritin, iron stores (can be falsely high during infection)
• Peripheral smear, shape of the red cells
• Stool test, worms, hidden blood
• HbA2 / hemoglobin electrophoresis, when thalassemia is suspected (very low MCV, high red cell count, family history, no improvement with iron)
• Sickle cell test, in communities at risk
• Vitamin B12, folate, if the red cells are large
• Malaria, celiac and kidney tests if needed

Treatment

1. Iron, the doctor decides the dose by weight; continued for 2–3 months even after hemoglobin becomes normal, to fill the stores.
2. How to give iron: on an empty stomach or between meals (with food if it upsets the stomach); with vitamin C (lemon water, orange, amla); not with milk, tea or calcium (1–2 hours apart); syrup can stain the teeth, so rinse or brush afterwards.
3. Side effects: black stools (normal), constipation, stomach ache; tell the doctor; do not stop on your own.
4. Worm treatment, with or before iron.
5. Hemoglobin check at 4 weeks, it should rise by at least 1 gram; if it does not, look for the cause again (iron given wrongly, thalassemia, hidden blood loss).
6. Severe anaemia, hospital, sometimes intravenous iron or blood transfusion.
7. B12/folate, thalassemia, sickle cell, specific treatment.

Extremely important precaution: keep iron tablets and syrups out of children’s reach; iron overdose is a major cause of poisoning in young children; coloured tablets look like candy. If a child swallows too much by mistake, go to hospital immediately.

Iron-Rich Home Food

Iron sources (vegetarian):

• Green leafy vegetables, spinach, fenugreek (methi), amaranth (tandaljo), drumstick leaves, radish leaves, bathua, dill (suva)
• Legumes and dals, chana, moong, masoor, rajma, chowli (black-eyed beans), soybean
• Jaggery (especially desi), jaggery with chana, jaggery with sesame
• Ragi, bajra, poha (iron fortified)
• Black sesame, pumpkin seeds, flaxseed
• Dates, black raisins, figs, apricots
• Beetroot, pomegranate (moderate in iron, but popular)
• Fortified foods, double fortified salt (iron + iodine), fortified rice and flour

In non-vegetarian families: eggs, fish, chicken, liver; “heme iron” is easily absorbed.

To increase absorption:

• Vitamin C with every iron-rich meal: squeeze lemon, amla, guava, orange, tomatoes, raw mango
• Sprouted legumes, fermented foods (dhokla, idli), better absorption
• Cooking in an iron kadhai or tava, adds iron to food (especially sour dishes)
• No tea or coffee with meals and for one hour after
• Milk at a different time from meals
• After 2 years, no more than 400–500 ml of milk a day

Simple Iron-Rich Recipes

• Spinach-methi thepla or paratha + curd + lemon
• Ragi sheera or raab, with jaggery
• Jaggery-chana, jaggery-sesame chikki
• Moong-spinach khichdi + lemon
• Chana chaat, with tomato and lemon
• Bajra rotla + methi sabzi + jaggery
• Date-almond laddoo (without sugar)
• Drumstick leaf soup or dal
• Beetroot-carrot-pomegranate salad (older children)

Useful Ayurvedic Support (in the vaidya’s child dose)

The right medicine, dose, anupana and timing are decided by the vaidya according to the person’s prakriti, age, other illnesses and current medicines.

1. Dhatri loha, amalaki (vitamin C) + loha, a classical pandu formulation.
2. Punarnava mandura / navayasa loha, traditional in pandu; the child dose is decided by the vaidya.
3. Drakshavaleha, grape-based, blood-building, improves taste; children like the taste.
4. Amalaki (amla), vitamin C, rasayana; helps iron absorption.
5. Bala chaturbhadra / hingvashtaka, agni deepana, appetite.

If there are worms, krimighna formulations such as vidanga (in coordination with the doctor’s deworming medicine). Extremely important: do not give loha-mandura formulations and modern iron syrup together on your own; the total iron dose can become too high and toxic. Tell both the doctor and the vaidya. Do not give loha formulations in thalassemia trait either. Only pure, certified products.

Gradual Ayurvedic approach: When hemoglobin is very low, Ayurvedic treatment at first runs alongside the doctor’s iron treatment, without stopping anything, and the two kinds of iron are not combined on your own but coordinated by the doctor and vaidya. Agni deepana and krimi nashana improve digestion and absorption, and loha formulations and diet nourish rakta dhatu, so appetite, glow and energy return. When hemoglobin becomes normal and stays stable, the doctor completes the modern iron course, and after that Ayurvedic diet and routine, the iron kadhai, seasonal rasayana and periodic krimi control prevent the deficiency from returning (apunarbhava). In inherited conditions like thalassemia there are no loha formulations; there Ayurveda is for strength, appetite and quality of life.

The Habit of Eating Mud (Pica)

• A symptom of iron deficiency; the craving often reduces with iron treatment
• Risk of worms, lead and infection
• Do not scold the child; understand the cause
• Keep mud, chalk and wall plaster out of reach; especially old wall paint (lead)
• Wash hands after playing outside, keep nails short
• If it continues even after 2 years, tell the doctor (also a development and behaviour assessment)

Prevention, Anaemia Mukt Bharat

• Mother in pregnancy, iron and folic acid, nutrition, worm treatment (in the second trimester, on the doctor’s advice)
• At birth, cutting the cord after a few minutes (decided by the doctor)
• Exclusive breastfeeding for 6 months, then iron-rich complementary food
• Government programme: 6–59 months, iron syrup twice a week; 5–10 years, weekly iron tablet (pink); 10–19 years, weekly (blue), free at school or anganwadi (dose and schedule as per local guidance)
• Deworming every 6 months (National Deworming Day)
• Footwear, handwashing, toilets, to prevent hookworm
• Protection from malaria, mosquito nets
• No tea with meals, a habit for the whole family
• Thalassemia testing before marriage, if both have the trait there is a risk of major in the child

Especially for Adolescent Girls

After periods begin, the risk of anaemia in adolescent girls rises a lot: menstrual blood loss, rapid growth and often dieting. Tiredness, hair fall and poor concentration in studies are often anaemia. Always take the weekly iron tablet given at school, eat iron-rich food, and see a doctor if periods are heavy. Today’s adolescent girl is tomorrow’s mother; her health is the health of the next generation.

The Parents’ Mind

“My child does eat, and drinks three glasses of milk,” and still anaemia? Many parents are surprised to hear this. Milk is nutritious but low in iron; too much milk takes the place of other food. Even a chubby-looking child can be anaemic. Instead of guilt, simple changes, green vegetables, jaggery and chana, lemon, no tea, limited milk, make a big difference.

By Season and Prakriti

Winter, plenty of green vegetables (spinach, methi, amaranth, dill), jaggery and sesame, bajra: the best time to raise iron; in Ayurveda also suitable for loha rasayana. Monsoon, risk of worms and malaria; wash and cook green vegetables well, protect from mosquitoes. Summer, amla and raw mango (vitamin C), sattu (chana), pomegranate. Pitta prakriti has a tendency to pandu, and dhatri (amla) based formulations suit it; in kapha, heaviness and swelling, light food, deepana; in vata, dryness and tiredness, ghee, dates and raisins.

Common Myths

• “Milk increases blood”, wrong; milk is low in iron.
• “A chubby child cannot have anaemia”, wrong.
• “Beetroot and pomegranate fix everything”, helpful but not enough; green vegetables, legumes and jaggery are more effective.
• “Hemoglobin is normal, stop the iron”, wrong; 2–3 months more.
• “Every anaemia is cured by iron”, not in thalassemia trait.
• “Give more iron syrup for quicker benefit”, dangerous.

Precautions

• Iron medicine out of children’s reach; overdose can be fatal.
• Breathlessness, swelling, extreme paleness, drowsiness: see a doctor immediately.
• Black sticky stools (without iron), vomiting blood: emergency.
• Do not combine modern iron and Ayurvedic loha formulations on your own.
• No improvement despite treatment: check for causes such as thalassemia.

Do’s and Don’ts

Do: CBC test, iron in the doctor’s dose (full course), green vegetables, legumes, jaggery and ragi, with vitamin C, the iron kadhai, deworming, footwear, handwashing, the government iron programme.

Don’t: too much milk, tea with meals, junk food, stopping iron halfway, keeping iron within reach, loha formulations without tests, scolding for eating mud.

Case Studies

Case 1: Milk, worms and mud (mridbhakshanajanya pandu)

6 years; tiredness, paleness, eating mud, poor appetite, poor concentration in studies; hemoglobin 8.2, low ferritin, worms in the stool. In Ayurvedic terms, mridbhakshanajanya pandu with agnimandya and krimi. Alongside the doctor’s worm treatment, the vaidya first improved appetite and digestion for two weeks with vidanga and agni deepana (bala chaturbhadra); then dhatri loha and punarnava mandura in a child dose, after the midday meal, with amla. In the diet, milk was limited to two cups, with jaggery and chana, dates, black raisins, green vegetables, cooking in an iron kadhai, no tea with meals, and roasted chana and dates kept handy for the craving for mud. The pediatrician checked hemoglobin every month. In the first month appetite opened up and mud eating reduced a lot; in three months hemoglobin was 11.9, with a glow on the face and better concentration in studies. (Results may vary from person to person.)

Case 2: Thalassemia trait, rasayana instead of loha

4 years; iron syrup for a year, yet hemoglobin around 10, tiredness, frequent colds, poor appetite; very low MCV, high red cell count. The HbA2 test showed thalassemia minor; here extra iron or loha formulations can cause harm, so iron was stopped. The vaidya took an approach without loha: agni deepana, iron-free rasayanas such as guduchi, amalaki and shatavari in a child dose, brimhana food such as ghee, milk and dates, regular abhyanga and sleep; folic acid as advised by the doctor. Hemoglobin stayed about the same (this is natural in thalassemia trait), but in six months appetite, weight and energy improved and colds reduced. The family was also given genetic counselling. This case shows that with the right diagnosis, Ayurveda can improve a child’s strength and quality of life even without loha. (Results may vary from person to person.)

Case 3: Adolescent girl, heavy periods and raktapradara

14 years; tiredness, hair fall, dizziness, heavy and prolonged periods, dieting; hemoglobin 9.5. The gynaecologist ruled out a serious cause. In Ayurvedic terms, pandu with raktapradara, pitta-predominant. For the heavy menstrual bleeding the vaidya gave raktastambhaka herbs such as ashoka and lodhra, along with dhatri loha and drakshavaleha in a child dose (with the doctor informed, not duplicated with the school iron tablet); dieting was stopped, with jaggery and sesame, beetroot, pomegranate, amla, dates, ragi, less spicy and fried food, and enough sleep. In two months the number of period days and the bleeding reduced; in four months hemoglobin was 12.4, tiredness and dizziness were gone and hair fall reduced. (Results may vary from person to person.)

When to See a Doctor (Red Flags)

• Extreme paleness, breathlessness, swelling
• Drowsiness, fainting
• Jaundice (yellow eyes), dark urine
• Black stools, blood in stools or vomit
• Frequent nosebleeds, bruises
• No improvement with iron at 4 weeks
• Thalassemia or sickle cell in the family

About Dr. Nikul Patel

Dr. Nikul Patel (BAMS) is an Ayurvedic physician at Lifecare Ayurveda and has been practising since 1999, that is, for 27 years. In pandu roga (anaemia) in children, he gives honest guidance on proper testing, iron-rich home food, worm control, agni deepana and safe Ayurvedic support in child doses, in coordination with the pediatrician.

Conclusion

Anaemia in children is common, but it is a condition that can be easily prevented and corrected. Find the cause with proper tests, and make Ayurveda’s pandu treatment the main path: agni deepana, krimi nashana, classical loha formulations such as dhatri loha and punarnava mandura, drakshavaleha, iron-rich home food with vitamin C, and limited milk and tea. Running alongside the doctor’s iron treatment at first, this approach works at the root by improving digestion and absorption, so when hemoglobin rises the deficiency does not keep coming back, and the child’s cheeks regain their colour and the eyes their sparkle. Every child’s results may differ.

VN

Dr. Nikul Patel (B.A.M.S.)

Ayurveda Consultant

Mobile: +91-98250 40844 WhatsApp ☎️ +91-79-40080844 📅 Online Appointment

lifecareayurveda@gmail.com info@lifecareayurveda.com

Atharva Ayurveda Clinic & Panchkarma Center
307, 3rd Floor, Shalin Complex, Above Farki Lassi, Krishnabaug Char Rasta, Maninagar, Ahmedabad – 380008
Timings: 10:00 AM to 1:00 PM and 3:00 PM to 6:30 PM | Saturday–Sunday: Closed
📍 Clinic Location — Google Maps

Ayurveda Websites: English Website | English Q&A

Social Media:YouTube•Facebook•Instagram•X

WhatsApp: Gujarati Group • Ayurveda Channel

Telegram Channels:ગુજરાતી•हिंदी•English

Telegram Groups:ગુજરાતી•हिंदी•English• Sexual Diseases / Sex Problems

Arattai: Ayurveda