Iron deficiency anemia - children

Definition

Iron deficiency anemia is a decrease in the number of red blood cells due to a lack of iron.

This article focuses on iron deficiency anemia in children.

Alternative Names

Anemia - iron deficiency - children

Causes, incidence, and risk factors

Iron deficiency anemia is the most common form of anemia. Iron is an essential part of hemoglobin, the oxygen-carrying protein in blood. You get iron through certain foods, and your body also reuses iron from old red blood cells.

Babies are born with about 500 milligrams (mg) of iron in their bodies. By the time they reach adulthood they need to have about 5,000 mg.

Children need to absorb an average of 1 mg per day of iron to keep up with the needs of their growing bodies. Since children only absorb about 10% of the iron they eat, most children need to receive 8-10 mg of iron per day. Breastfed babies need less, because iron is absorbed 3 times better when it is in breast milk.

An iron-poor diet is a common cause of iron deficiency. Drinking too much cow's milk is a common cause of iron deficiency in young children because cow’s milk contains little iron and can get in the way of iron absorption. Cow's milk also can cause problems in the intestine that lead to blood loss and increased risk of anemia.

Iron deficiency most commonly affects babies between 9 - 24 months old. All babies should have a screening test for iron deficiency at this age. Babies born prematurely may need to be tested earlier.

The adolescent growth spurt is another high-risk period.

Iron deficiency in children can be related to lead poisoning or slow bleeding.

Symptoms

• Blue-tinged or very pale whites of eyes
• Blood in the stools
• Brittle nails
• Decreased appetite (especially in children)
• Fatigue
• Headache
• Irritability
• Pale skin color (pallor)
• Shortness of breath
• Sore tongue
• Unusual food cravings (called pica)
• Weakness

Note: There may be no symptoms if anemia is mild.

Signs and tests

The health care provider will perform a physical exam. A blood sample is taken and sent to a laboratory for examination. Red blood cells appear small when looked at under a microscope.

Specific tests that may be done include:

• Hematocrit
• Serum ferritin reveals the amount of iron stored in your body
• Serum iron shows how much iron is in your blood
• Total iron binding capacity (TIBC) to measure the ability of a protein called transferrin to carry iron in the blood

Treatment

Treatment involves iron supplements (ferrous sulfate), which are taken by mouth. The iron is best absorbed on an empty stomach, but many people need to take the supplements with food to avoid stomach upset.

If you cannot tolerate iron supplments by mouth, iron may be given by injection into a muscle or through a vein (IV).

Milk and antacids can interfere with iron absorption and should not be taken at the same time as iron supplements.

Iron supplements are needed during pregnancy and breastfeeding because diet alone rarely supplies the needed amount.

Iron-rich foods include raisins, meats (especially liver), fish, poultry, egg yolks, legumes (peas and beans), and whole-grain bread.

Expectations (prognosis)

With treatment, the outcome is likely to be good. In most cases, the blood counts will return to normal in 2 months.

However, you should continue taking iron supplements for another 6 to 12 months, or as your health care provider recommends. This will help the body rebuild its iron storage.

Iron supplementation improves learning, memory, and cognitive test performance in adolescents who have low levels of iron. Iron supplementation also improves the performance of athletes with anemia and iron deficiency.

Complications

Iron deficiency anemia can affect school performance. Low iron levels are an important cause of decreased attention span, reduced alertness, and learning difficulties, both in young children and adolescents.

Prevention

Diet is the most important way to prevent and treat iron deficiency.

Good sources of iron include:

• Apricots
• Kale and other greens
• Oatmeal
• Prunes
• Raisins
• Spinach
• Tuna

Better sources of iron include:

• Chicken and other meats
• Dried beans and lentils
• Eggs
• Fish
• Molasses
• Peanut butter
• Soybeans
• Turkey

The best sources of iron include:

• Baby formula with iron
• Breast milk (the iron is very easily used by the child)
• Infant cereals and other iron-fortified cereals
• Liver
• Prune juice

References

Wu AC, Lesperance L, Bernstein H. Screening for iron deficiency. Pediatr-Rev. May 2002;23:171-178.

Glader B. Iron-deficiency anemia. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 455.