This article was last reviewed on
This article waslast modified on
23 May 2018.

In medicine, screening is defined as testing for disease when no signs or symptoms are present. All newborn babies in the UK are now screened during the first week of life for five inherited disorders: Phenylketonuria (PKU), Congenital Hypothyroidism (CHT), Medium-chain Acyl CoA Dehydrogenase Deficiency (MCADD), Cystic Fibrosis (CF) and the Haemoglobinopathies including Sickle Cell Disease (SCD). In the UK, there is also a pilot study underway to determine whether babies would benefit from being screened for five further diseases not currently screened for: maple syrup urine disease, homocystinuria (pyridoxine unresponsive), isovaleric acidaemia, glutaric aciduria type 1 and long-chain hydroxyl acyl-CoA dehydrogenase deficiency. The pilot study will run for 12 months from 16th July 2012 to 19th July 2013.

Although targeted screening of older infants may be important for the early detection, diagnosis, and treatment of certain conditions that may not have been discovered in the newborn period, there is currently insufficient evidence to support population screening for any of these conditions. However, for those infants with known risk factors, testing may be appropriate and include conditions such as iron deficiency, lead poisoning, Tuberculosis (TB) and HIV.

A physical screening programme is performed by physical examination, usually prior to 18 months of age, to check for normal growth and development.

Immunisation against a variety of diseases is also offered to infants. These diseases include diphtheria, tetanus, pertussis (whooping cough) – (DTP), Haemophilus influenzae type b (HiB), measles, mumps, rubella (German measles) - (MMR), polio and Group C meningococcus. Hepatitis B vaccine is offered to all babies born to hepatitis B positive mothers. Some of these are series of injections that are started before the age of one year

(See the NHS Immunisation schedule).

Tests
  • Iron deficiency anaemia

    Infants grow and develop rapidly and need iron in their diet to for their normal development. For the first 4 to 6 months, an infant can rely on their body's own storage supply of iron. After that, if an infant does not consume enough iron, there is a risk of developing iron deficiency.

    Iron deficiency can cause anaemia which means that the ability of red blood cells to transport oxygen around the body is impaired. Anaemia can lead to tiredness and increase susceptibility of infants to infections. Iron deficiency anaemia occurring in the infant / toddler may also cause immediate and longer term problems of intellectual and behavioural development in childhood.

    Premature and low-birth-weight babies are at greater risk of iron deficiency. Breast-fed babies, on the otherhand, usually obtain enough iron unless the nursing mother's own supply is low. Early use and overuse of cow's milk exacerbates existing causes of iron deficiency in infants.

    Less often, iron deficiency anaemia may be occur due to a severe blood loss. It may also occur if there is something interfering with the body's ability to absorb iron, such as a medication the infant is taking or a chronic illness.

    Risk factors for iron deficiency anemia in infants and young children include:

    • Premature birth or low birth weight
    • Infants with ethnic minority groups
    • Households with a low income or living in poverty
    • Prolonged milk feeding, where milk remains the main food source after 6 months
    • A lack of iron containing foods in the weaning diet of infants
    • History of:
      • Medications that interfere with iron absorption, or
      • Extensive blood loss, or
      • Chronic infection or inflammation, or
      • Restricted diet

    Recommendations

    The current UK policy is that screening for iron deficiency anaemia in infants should not be conducted. Rather, the Institute of Child Health recommends that the emphasis should be on prevention of iron deficiency by promoting a healthy diet. Advice for the prevention of iron deficiency includes:

    • If an infant is not breastfed, then infant formula (with added iron) should be used, rather than cow’s milk, for the first 12 months.
    • If an infant is breastfed, then a variety of weaning foods should be provided to the infant from 6 months of age.


    Links

    Iron deficiency anaemia in toddlers
    NHS choices: Baby's first solid foods