Favism (G6PD Deficiency) in Children: Fava Beans, Henna, Medicines and Precautions

In spring, fresh fava beans arrive in Moroccan markets, and with them bissara (fava bean soup), tajines and boiled beans with cumin. For most children, it is a treat. For those with favism, it is a real danger: a few beans can be enough to destroy red blood cells on a large scale.

Favism is the common name for G6PD deficiency, a genetic trait that is frequent around the Mediterranean. It is well known and allows a perfectly normal life. You just need to know what to avoid, and how to recognise a crisis.

What is G6PD deficiency?

It is the lack of an enzyme, glucose-6-phosphate dehydrogenase (G6PD), which protects red blood cells against oxidative stress. Without it, these cells become fragile. On contact with certain substances, they burst: this is haemolysis, which causes a sudden anaemia known as haemolytic anaemia.

The condition is passed on through the X chromosome, as La Revue du Praticien reminds us. Boys are therefore the most affected. Girls are often carriers without symptoms, but some have a marked deficiency.

Is it common in Morocco?

The deficiency is one of the most widespread genetic disorders in the world: more than 500 million people according to La Revue du Praticien, at least 420 million according to other estimates. It is particularly frequent around the Mediterranean basin, in Africa, the Middle East and Asia.

The so-called Mediterranean variant, found mainly in North Africa, is among the most severe forms, notes Allo Docteurs. We did not find a recent, reliable national figure for Morocco. If a family member has ever had a crisis after eating fava beans, tell the paediatrician as soon as your baby is born.

How is the deficiency discovered in a baby?

Often through marked jaundice in the first days of life. The VIDAL reference text states that newborn jaundice linked to the deficiency begins around day 2 or 3. Strong jaundice, especially in a boy whose family comes from an at-risk region, leads doctors to look for the deficiency. Other causes of jaundice are covered in our article on newborn jaundice.

In other cases, the diagnosis comes after a first crisis, at any age. It is made with a blood test that measures enzyme activity, taken some time after a haemolysis so that the result is reliable. To find out which tests are or are not done at birth, see your baby's first tests.

Which triggers should you avoid?

Fava beans, in every form

This is the only food whose role is demonstrated, according to Anses. Fresh fava beans, raw or frozen, are the most dangerous, especially for children. Cooking is not enough: the substances involved resist it quite well. The French guidance is therefore clear: no fava beans at all, whatever the way they are prepared.

In a Moroccan kitchen, that means:

• no bissara, and no fresh or dried fava beans in the tajine, the couscous or the salad;
• no fava flour or food supplements that contain it, as the French health directorate (DGS) points out;
• care with dried-vegetable mixes and powdered purées: read the ingredients.

Other pulses, lentils, chickpeas, peas or beans, cause no known problem.

Quinine drinks and vitamin C supplements

French authorities advise against tonic sodas containing quinine and against vitamin C food supplements. Fruit and vegetables rich in vitamin C remain allowed, in normal amounts.

Certain medicines

This is the most delicate point. The French medicines agency sorts many molecules into three categories: contraindicated, not recommended, or possible provided maximum doses are strictly respected. They include certain antibiotics, antimalarials and even common painkillers. The full list is long and changes over time. Your doctor will give you the one that applies to your child.

The habit to build: say "G6PD deficiency" before every prescription, every purchase at the pharmacy, every visit to the emergency department. A breastfed infant can also react to a medicine taken by their mother, stresses La Revue du Praticien. Keep an up-to-date list in your baby's medicine cabinet.

Infections

Infections, especially viral ones, are a frequent trigger. A fever in an affected child therefore deserves medical advice sooner than usual.

Henna and other products

Natural henna contains a molecule, lawsone, implicated in haemolysis in newborns with the deficiency after a paste was applied to the skin. The journal Médecine Tropicale cites cases in Turkey, Kuwait, Sudan, Oman and the Emirates, and recommends not applying it to affected children. In Morocco, where henna goes with the sbou3 (the baby-naming celebration), Ashura or family celebrations, the rule is simple: no henna on a baby or child with the deficiency. The other precautions, valid for every child, are detailed in our article on henna for children.

SickKids hospital in Toronto adds naphthalene mothballs to the list: the child must not be in close contact with them. So no mothballs in the wardrobes where you keep their clothes or bed linen. The same document also mentions certain hair dyes and henna tattoos, black or red.

How do you recognise a haemolytic crisis?

Signs generally appear from a few hours to two days after eating fava beans, taking a risky medicine or the start of an infection, according to La Revue du Praticien. French sources describe:

• paleness appearing suddenly;
• jaundice: yellow skin and whites of the eyes;
• dark urine, the colour of tea or cola;
• great tiredness, a limp child with no appetite;
• fever, headaches;
• pain in the tummy or lower back.

A crisis can be serious, even fatal in a child. It can also damage the kidneys. It needs prompt hospital care.

Living with favism day to day

Most affected children will never have a crisis if those around them know the rules. Tell the whole family, including whoever cooks the festive meals. At nursery and then at school, inform the management in writing. In France, the school can draw up an individual care plan; in Morocco, a letter from the paediatrician handed to the school plays the same role.

As your child grows, teach them to refuse fava beans at friends' houses and to state their diagnosis themselves. The deficiency does not prevent sport, travel or a rich, varied diet. For the rest of their diet, iron in particular, see our article on anaemia and iron deficiency.