Hemoglobin Status and Externalizing Behavioral Problems in Children

Abstract

Background: Still considered one of the most prevalent nutritional problems in the world, anemia has been shown in many studies to have deleterious effects on neurobehavioral development. While most research efforts have focused on investigating the effects of anemia on social and emotional development of infants by using a cross-sectional design, research is still needed to investigate whether early childhood anemia, beyond infantile years, is linked with behavioral problems. Objective: This study assessed whether (1) hemoglobin (Hb) levels in early childhood are associated with externalizing behavior; and (2) this relationship is confounded by social adversity. Methods: Hemoglobin levels were taken from children (N = 98) of the China Jintan Cohort Study at age 4 years, and externalizing behaviors (attention and aggression) were assessed with the Child Behavior Checklist (ASEBA-CBCL) at age 6 years (mean age 5.77 ± 0.39 years old). Results: Compared with other children in the sample, children with relatively lower Hb levels at age 4 had more behavioral problems in both attention and aggression at age 6, independent of social adversity. For boys, this association was significant for attention problems, which did not interact with social adversity. For girls, the association was significant for aggression, which interacted with social adversity. While girls on average exhibited higher social adversity than boys, the main effect of Hb was only significant in girls with low social adversity. Conclusions: These results indicate that there is an inverse association between hemoglobin levels and later behavioral problems. Findings of this study suggest that regular monitoring of children’s hemoglobin levels and appropriate intervention may help with early identification of behavioral problems.

Anemia prevalence, severity and associated factors among children aged 6–71 months in rural Hunan Province, China: a community-based cross-sectional study

“…Childhood anemia will adversely affect the health of children, including physical development, and may cause irreversible damages to motion, cognitional and behavioral development [3,20,21]. The age from 0 to 6 years old is the critical period for children's growth and development, and it is also a high age group for anemia.…”

The association of early linear growth and haemoglobin concentration with later cognitive, motor, and social–emotional development at preschool age in Ghana

“…These studies have focused on cognitive scores or educational achievement, with only one assessing motor (Kuklina et al, 2006) and none assessing social-emotional development. Although several studies have examined relationships of Hb concentration during early life with long-term developmental outcomes (Ai, Zhao, Zhou, Ma, & Liu, 2012;Aubuchon-Endsley et al, 2011;Aubuchon-Endsley et al, 2013;Eilander et al, 2010;Grantham-Mcgregor & Ani, 2001;Jianghong, Adrian, Venables, & Mednick, 2004;Olney et al, 2009;Su et al, 2016), only one study to our knowledge reported independent associations with Hb during specific periods of childhood by adjusting for Hb at other time points (Aubuchon-Endsley et al, 2013).…”

Efecto de la anemia en el desarrollo infantil: consecuencias a largo plazo

“…Por otro lado, un estudio en China encontró que los niveles bajos de hemoglobina en niños de cuatro años, estuvieron asociados a problemas de conducta externalizada a los 6 años, asociación que no se vio afectada con problemas de adversidad social (27) . Hubo, además, una diferencia según sexo en la manifestación conductual a los seis años, los niños tenían más problemas de atención, mientras que las niñas presentaron mayor agresión (27) .…”

“…Hubo, además, una diferencia según sexo en la manifestación conductual a los seis años, los niños tenían más problemas de atención, mientras que las niñas presentaron mayor agresión (27) . Este estudio presenta algunas limitaciones como el poco tamaño de muestra, se reporta solo niveles bajos de hemoglobina y no anemia, y no mencionan otras medidas que evalúan la malnutrición como el peso y talla (27) .…”

“…Hubo, además, una diferencia según sexo en la manifestación conductual a los seis años, los niños tenían más problemas de atención, mientras que las niñas presentaron mayor agresión (27) . Este estudio presenta algunas limitaciones como el poco tamaño de muestra, se reporta solo niveles bajos de hemoglobina y no anemia, y no mencionan otras medidas que evalúan la malnutrición como el peso y talla (27) . Entre las limitaciones de las revisiones sistemáticas podemos mencionar que combinaban muchos tipos de evaluaciones (mental y motora), otros no consideraron la diferencias de edad, ni los instrumentos con los cuales se evaluó el desarrollo mental o motor (20) .…”