Children can often appear tired or irritable, but when these symptoms become an ongoing problem, it could be a sign of something more serious.

Fatigue, pale skin, and even a bad mood can be signs of anemia — especially in babies who were born preterm, with low birth weight, or whose cords were clamped immediately after being born.

Anemia is the most common nutritional deficiency in the world, and anemia caused by iron deficiency and other problems can be concerning not only for the symptoms they cause but also for the long-lasting developmental effects that can follow.

This article will help you understand what anemia is and the different forms of this condition, as well as what to expect if your child develops anemia.

Anemia occurs when the number of red blood cells in a person’s blood is lower than normal or when the amount of hemoglobin in the red blood cells is too low.

Hemoglobin is a protein in your red blood cells that carries oxygen throughout your body and removes carbon dioxide. Low hemoglobin levels could mean that too little oxygen or too much carbon dioxide is in your body.

There are many ways anemia can develop. Below are some of the different types of anemia, and an explanation of how each causes symptoms.

Iron deficiency anemia

Iron is a mineral that your body needs in order to make hemoglobin. Low levels of iron — often from poor dietary intake — can decrease the amount and efficiency of hemoglobin in your body.

Iron-deficiency anemia is the most common type of anemia. Despite how common this condition is, many people don’t know they have iron-deficiency anemia and chalk their symptoms up to other causes.

Microcytic anemia

These types of anemias are defined by the size of your red blood cells. In people with microcytic anemia, red blood cells are smaller and paler than they should be. This indicates a decrease in their ability to transport oxygen.

While iron deficiency is a leading cause of this type of anemia, other causes can include:

Determining the underlying cause for the specific type of microcytic anemia a person has is key to effective treatment.

Macrocytic anemia

Macrocytic anemias result from red blood cells that are too large. These larger red blood cells aren’t mature, so they don’t perform the same work as normal red blood cells.

Macrocytic anemias are split into two categories:

  • Megaloblastic anemia: This occurs when the problem is caused by a DNA error in how your blood cells are produced.
  • Nonmegaloblastic anemia: This occurs when the cause is other factors like medications or lifestyle choices.

Megaloblastic anemias are often caused by things like:

Nonmegaloblastic forms are caused by things like:

  • chronic alcohol use
  • liver disease
  • hypothyroidism

Hemolytic anemia

Hemolytic anemia is a type of anemia where your red blood cells are normal in size, shape, and function, but their lifespan is cut short.

Every cell type has a normal lifespan, but in hemolytic anemia, something causes your red blood cells to die off quickly or prematurely — and faster than they can be replaced.

Extrinsic hemolytic anemia is the name given to anemias in this category that are caused by some sort of malfunction that destroys your red blood cells. Examples include things like:

Hemolytic anemias can also have an intrinsic cause, which develops because your red blood cells don’t function as they should. Examples include sickle cell anemia and thalassemia.

Sickle cell anemia

Sickle cell anemia is a type of intrinsic hemolytic anemia. With this form of anemia, red blood cells are C-shaped and become sticky and rigid. This abnormal shape makes these cells prone to becoming stuck in blood vessels, causing pain, tissue damage, and even blood clots.

Not all red blood cells are affected with the sickle shape, but it’s usually enough to produce noticeable symptoms of anemia. There are several forms of sickle cell anemia, but all are inherited genetic conditions that usually appear in the first few months of a child’s life.


Thalassemia is the name given to a group of blood disorders that affect the proteins that make up hemoglobin.

Hemoglobin is made up of two types of proteins — alpha and beta — and the type of thalassemia you have is determined by whether you’re deficient in alpha or beta proteins.

A deficiency in beta proteins creates the more severe type of thalassemia, often called thalassemia major or Cooley’s anemia. This form of the condition, due to a complete lack of beta proteins, creates a life threatening shortage of hemoglobin function that requires lifelong and regular blood transfusions.

Cooley’s anemia usually appears before the age of 2, and over time can cause complications because of iron buildup from so many blood transfusions.

Aplastic anemia

Aplastic anemia is a type of anemia where for one reason or another, your bone marrow just doesn’t produce enough red blood cells.

There are lots of things that can cause damage to bone marrow, and often the cause of this kind of anemia has multiple contributors or is unknown altogether.

Some possible contributors to aplastic anemia include:

  • chemotherapy
  • radiation
  • autoimmune disease
  • certain viruses like Epstein-Barr and HIV

The symptoms of anemia in kids are similar to those in adults. But, depending on their age, they might have a hard time telling you how they feel.

Some of the most common symptoms seen in children who have iron-deficiency anemia include:

Other forms of anemia can present with a variety of symptoms, but the condition can also develop with no symptoms at all. In some cases, anemia might be diagnosed through blood work done for other purposes.

The cause of anemia depends on the type, but for many children, the condition is the result of an inherited or genetic condition that affects how red blood cells form or function.

Iron-deficiency anemia in infants and young children is usually linked to diet, due to a delay in introducing iron-fortified foods or iron supplements. Food allergies and other feeding difficulties can also contribute to the condition.

The main causes of microcytic anemias in children may also include:

  • infections
  • thalassemia
  • iron deficiency

Normocytic anemias in children are often caused by things like:

  • blood loss
  • autoimmune attacks on red blood cells
  • infections
  • iron deficiency
  • sickle cell disease
  • hemolytic diseases
  • bone marrow disorders
  • other red blood cell disorders

Macrocytic anemias in children are usually caused by problems that include:

  • congenital aplasia
  • vitamin B12 deficiency
  • folate deficiency
  • hypothyroidism
  • hypersplenism

It can be difficult to make a diagnosis of anemia in young children because symptoms can be mild or shared with a number of other conditions.

Your doctor will begin working on a diagnosis by asking about individual and family medical histories, other conditions, medications, diet, and development.

A complete blood count (CBC) is a test done on a sample of blood taken in a lab, and it’s the most common diagnostic test for anemia. This test will give a count of all blood cell types in a sample.

Anemia can be diagnosed by comparing your child’s red blood cell count and hemoglobin level to normal ranges.

What’s a normal hemoglobin level?

Normal hemoglobin levels in children vary by age but can range from about 9 g per dL to 16.5 g per dL.

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How anemia in children is treated will depend on:

  • how severely anemic your child is
  • the type of anemia
  • any underlying conditions contributing to the problem

Iron-deficiency anemia is the most common type of anemia in children and is usually treated with iron supplementation and diet changes. If iron supplements are required, your doctor will recommend a specific formulation and dosing based on your child’s age and level of iron deficiency.

In milder cases, or alongside supplementation, your doctor may also suggest increasing the amount of iron-fortified or iron-rich foods in your child’s diet. This can include foods like:

  • red meat
  • seafood
  • poultry
  • eggs
  • iron-fortified cereals
  • beans and lentils
  • dark green, leafy vegetables

In addition to adding iron-rich foods to your child’s diet, it’s also helpful to increase iron absorption in the body by pairing these with vitamin C-rich foods like:

  • citrus fruits
  • berries
  • papaya
  • tomatoes
  • sweet potatoes
  • broccoli
  • cabbage
  • dark green, leafy vegetables

In cases of severe anemia or certain types, such as Cooley’s anemia, your child may require blood transfusions or other ongoing treatments.

There are several forms of anemia that are inherited or run in families, so a family or parental history of anemia can indicate a certain level of risk.

Beyond that, a number of factors can increase the risk of developing anemia. These include:

Symptoms of anemia in children may go unnoticed, or even be chalked up to normal growth cycles. Be sure to discuss your child’s diet and the recommended amounts of iron your child requires at routine well visits.

If you see any signs of severe bleeding, fatigue, or lethargy, visit or call your pediatrician or healthcare professional.

Iron-deficiency anemia is the most common form of this condition among young children, and it’s usually treated through diet and supplementation.

In most cases, anemia is a short-term, treatable condition. In some cases, however, children with certain other forms of anemia may require ongoing medical treatment to maintain their blood counts and prevent complications like organ failure.

Anemia in children can appear as fatigue, paleness, irritability, or even cognitive problems.

In most cases, anemia in kids can be attributed to iron deficiency. Diet changes and supplementation can help. More severe cases — especially with specific genetic causes of anemia — may require ongoing care and treatment, which includes regular blood transfusions.

If you think your child has iron deficiency or anemia, talk with your pediatrician. They can do blood testing and provide guidance on treatment.