Low Energy Levels In A Child

by NM
(Mumbai )

My 8 years old son regularly complains of tiredness after the daily routine activities for the age. His energy levels are generally low.

He is interested in outdoor games and other physical activities that a boy at this age would like to enjoy.

However, due to lack of stamina, he needs to push himself to be able to participate even in his favorite sports. This not only masks his enjoyment but also is a cause of our concern.

He is otherwise healthy, has had no major sickness and is from a happy well provided family.

Given below are the latest blood test results.

- HB 11.4 grams percent(last month it was 10.6)

- Hematocrit is at 34.1 (normal range of 35-45)

- Lymphocytes at 51(normal range of 28-48)

- TIBC (total iron binding capacity) - 327

- Serum Iron - 99

- Retic count - 2

- Ferritin - 47.4

- Hemoglobin variant analysis - within the normal range.

Stool test showed no abnormality. It was advised to rule out worm infestation as the possible cause of anemia.

Since the earlier blood test result that showed hemoglobin of 10.6, we have not given him any iron supplements. Nevertheless, foods of high iron content (like dates,spinach,beetroot,fruits etc.) were religiously included in the diet.

Consequently, the hemoglobin has shot up by 0.8 grams percent with in a month, but the energy level continues to be the same.

Please suggest the way forward. Regards, NM.

The Expert, Ren Chats Answers -


At the onset let me appreciate your approach of introducing foods known to be rich in iron in your son’s diet against iron supplements purchasable off the counter.

Introducing healthy food habits at this age certainly has much more lasting effect on child health.

I am sure visitors to this page will learn from your example – a parent’s own positive experiences.

Your concern is fully justified. The low levels of energy and borderline anemia are the outward manifestations of some underlying cause.

The blood results you have sent across suggest a borderline microcytic anemia.

Iron deficiency is the commonest cause of microcytic anemia. Iron is also essential for the synthesis of neurotransmitters and so for the optimal neurological functions.

Iron is preferentially utilized for hemoglobin production over that of the neurotransmitters. Therefore iron deficiency can exist without the low hemoglobin levels.

In your child’s case, though serum iron values are well within normal limits, hemoglobin is at the lowest limit of normal and TIBC of 327 falls at higher limit of normal (250-400 micro gram/dl) for the age. This discrepancy prompts me to rule out other possibilities.

High levels of lead in the blood can result in microcytic anemia and low energy levels in children.


Accepted blood lead level is < 10 micro grams percent (toxic levels at 70 or more), but studies have shown that early symptoms like pallor (anemia), weakness and irritability are noticed even at lower blood lead levels in children.

Industry wastes, constructions, house paints and fuel exhaust in big cities contribute to the high levels of lead pollution in the air.

Lead intake also occurs through food (plants absorb heavy metals from the soil) and water (supplied through lead pipes).

Spherocytosis also needs to be considered. The reticulocyte count of 2 percent comes to corrected reticulocyte count (CRC) of 1.7 to 1.9, which is borderline high than expected (1.5). This suggests a possibility of mild haemolysis.

Chronic low grade infection, hidden autoimmune disorder and hormonal imbalance also contribute to the feeling of low energy among growing children.

Low energy levels among tweens are often as a result of modern lifestyle –

Media exposure of more than 14 hours per week is deleterious for child health - recommended is 1 hour/day with 2-3 hours during weekends.

Depression is well documented in children who spend more than 2 hours/day watching television, playing computer games, watching movies in cinema hall and browsing internet.

This jeopardizes –

i. Social interaction with peers.

ii. Sleep – inadequate or disturbed sleep leads to constant feeling of fatigue.

iii. Ability to keep up with school curriculum.

iv. Security by exposing children to cyber bullying, Facebook depression and/or sexting.

My suggestions in sequence of priority are enumerated below –

1. Continue with diet rich in iron content

2. Educate the child on safe usage of media and control over indulgence in television viewing, computer usage, internet browsing, movies and video games.

3. Meet child’s school-teachers and mingle with the peers to find if there is any cause for depression.

Loss of energy could be very early sign of depression. Due to the ambiguity of its symptoms and lack of diagnostic tests, depression, at its early stages, often gets overlooked even by the doctors.

4. Record monthly weight and height on age and sex specific growth chart.

In event of an abnormality noted (minimum over next 3 months) consult your doctor. Take the growth charts along.

Properly maintained growth charts are a great tool for early diagnosis of hormone disorder in a growing child.

5. Exposure to direct sunlight for about half an hour every day stimulates the neuroendocrine system to secrete hormones and energizes the child.

6. Blood tests --

i. ESR and CRP to rule out infection.

ii. Erythrocyte fragility test for spherocytosis.

iii. Blood lead levels.

iv. Blood sugar and corresponding urine sugar to rule out diabetes.

v. Blood urea and serum creatinine to evaluate kidney functions.

vi. FEP (Free erythrocyte protoporphyrin) to be considered only if no other clue is found. Its value of >300 micrograms/dl is suggestive of lead toxicity.

To read more details, please click on related pages on the site. However, if you have more questions on the subject, then you can post it as your comment here - so the link continues.

Hope this will help you. Regards.

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