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Iron-Deficiency Anemia

When you think of iron, you might think of skyscrapers with metal beams infused with iron to make them strong. But people need iron to stay strong, too.

Iron helps red blood cells carry oxygen to the body and plays a key role in brain and muscle function. A lack of iron in the blood can lead to iron-deficiency anemia, a common nutritional deficiency in children.

About Iron-Deficiency Anemia

Every red blood cell in the body contains iron in its hemoglobin, the protein that carries oxygen to the body's tissues from the lungs. Iron gives hemoglobin the strength to "carry" (bind to) oxygen in the blood, so that oxygen gets to where it needs to go.

People who become iron deficient aren't getting enough iron in their diet. This means that the body can't make hemoglobin, so it makes fewer red blood cells. This is a condition called anemia. When someone has anemia, less oxygen reaches the cells and tissues and affects how the body works.

Iron plays an important role in muscle function, energy creation, and brain development. As a result, a child with iron deficiency may have learning and behavioral problems.

Causes

In developed countries, getting enough iron in the diet is not usually a problem for healthy babies. In general, breastfed babies tend to get enough iron from their mothers until they start other foods and liquids. As long as formula-fed infants drink formula that is fortified with iron, they also usually get enough iron.

Toddlers can run into problems if they drink too much cow's milk (more than 24 ounces a day) and eat fewer iron-rich foods, like red meat and green leafy vegetables. Cow’s milk is not a good source of iron. In fact, milk makes it harder for the body to absorb iron and can contribute to iron-deficiency anemia.

Older picky eaters may not eat foods with enough iron, and sometimes parents have trouble finding healthy foods that are high in iron. Kids or teens on a vegetarian diet also might not get enough iron, because iron from meat sources is more easily absorbed than iron from plant sources.

Teenage boys sometimes develop iron deficiency during the rapid growth of puberty. But teen girls have iron deficiency more often because their bodies can't store as much iron and lose blood during menstruation. Young athletes who exercise often tend to lose more iron and may also become iron deficient.

Symptoms

Iron-deficiency anemia develops over time. First, the amount of iron in the body goes down and the child starts to have iron deficiency, where muscle and brain function are affected. The red blood cells don't change much at this point because the body uses most of its iron to make hemoglobin.

But in time, as the iron is used up, the body starts making fewer red blood cells and becomes anemic. At that point, symptoms may include:

  • tiredness and weakness
  • pale skin, especially around the hands, nails, and eyelids
  • rapid heartbeat or a heart murmur
  • irritability
  • low appetite
  • dizziness or feeling lightheaded

In rare cases, a child with iron-deficiency anemia may develop pica, a craving to eat nonfood items such as paint chips, chalk, or dirt.

Diagnosis

Iron-deficiency anemia is often first noticed during a checkup. Babies should receive blood testing for anemia within their first year. Doctors sometimes screen earlier for certain children, such as premature babies, who have lower amounts of iron in their bodies at birth than full-term babies.

A doctor may consider the possibility of iron deficiency in an older child who is tired and looks weak. The doctor will likely ask questions about the child's diet and growth and may do a blood test to check for low hemoglobin or iron levels, which could mean the child has anemia. The doctor also may do a stool test because iron-deficiency anemia can sometimes be caused by the gradual loss of small amounts of blood through the intestinal tract.

Treatment

Usually, kids with iron deficiency need to take daily iron supplements to get their iron levels back up. Multivitamins with iron and changes to a child's diet can help, but usually are not enough on their own. Ask a doctor before giving your child iron supplements, as too much iron can cause health problems.

Iron should be taken on an empty stomach or with a small amount of food. Avoid giving a child iron with milk or caffeinated drinks because both prevent the iron from absorbing well. Things like orange juice and other foods that are high in vitamin C can make iron absorb better.

Within a day or two of starting iron, children should feel better and have a better appetite. Over the next month, as the blood makes more red blood cells, their hemoglobin levels should go up. It usually takes 3-6 months of iron supplements to correct the deficiency, but sometimes kids are treated for longer periods.

If the treatment doesn't work, it's usually because the child's body is not properly absorbing the iron or the child is getting the wrong dose. In these cases, the doctor probably will do a blood test to see how the iron levels have responded. Kids with severe cases of iron-deficiency anemia may require treatment from a specialist or a blood transfusion.

Prevention

Preventing iron deficiency in the first place can help kids avoid long-term behavioral and learning problems. Here are some tips:

  • Infants younger than 1 year old should drink only breast milk or an infant formula that contains iron. Breastfed infants should eat iron-fortified solid foods starting at about 6 months of age.
  • Kids under 2 should have no more than 24 ounces of whole milk a day. Iron-fortified products such as cereal can be a great way to help young children to get more iron.
  • Good sources of iron include: red meats, dark poultry, salmon, tuna, egg yolks, green leafy vegetables, dried peas and beans, molasses, dried fruits and raisins, and enriched whole-grain bread. Serve these alongside foods or drinks rich in vitamin C (tomatoes, broccoli, orange juice, strawberries, etc.), which improves the body's absorption of iron.
  • Try cooking food in a cast iron pan, which can help enrich the food with iron.

Reviewed by: Rupal Christine Gupta, MD
Date reviewed: October 2014