Iron Deficiency Anemia: What It Is and How to Help Your Child

I recently cared for a child who was admitted to our unit for iron deficiency anemia and worked with Sarah White, MD, to provide some family education on this very common anemia, what the cause is, the symptoms and the treatment. I am partnering with White again to discuss iron deficiency anemia for readers of this blog.

The basics

Iron deficiency anemia is the most common form of anemia. It is caused by not having enough iron in the diet. Iron is in a part of the red blood cells called hemoglobin, which carries oxygen around the body. If there is not enough iron in the diet, the body cannot make enough hemoglobin, which means there are fewer red blood cells. That is called anemia.

Iron is needed in the body to help muscles work, give us energy and help with the functioning of the brain. It is even more important for children because they need it to grow. Babies get iron from the mother in the last trimester of pregnancy, so babies who are at risk for not getting enough iron are premature babies or multiples (twins, triplets, etc.), who have to share the amount of iron given by mom. Breastfed babies will get iron from mom, or if they get fortified formula they will get enough iron. But when babies start to eat, they need to be given a diet rich in iron.

Iron deficiency anemia can be seen in children who take in too much cow’s milk. Cow’s milk is low in iron, and often the child gets full from the milk and doesn’t eat enough iron-rich foods. If the child does eat iron-rich food, the cow’s milk prevents it from being absorbed. Cow’s milk can also cause a very small amount of hidden bleeding, and so iron is also lost. Cow’s milk is not recommended for children under 1 year; from ages 1-2 years old whole milk is recommended. Thereafter, children should be given skim milk. Unfortified cow’s milk can be dangerous for babies or children if they get dehydrated from diarrhea, and it also has too much protein, which can lead to obesity later in life. How much cow’s milk is too much? For toddlers, more than 16 to 24 ounces a day is excessive. The child may also be a picky eater, so it is important to offer a variety of iron-rich foods.

How might you know if your child has iron deficiency anemia?

• Irritability
• Shortness of breath
• Craving for unusual things, like dirt, paint, starch, ice
• Not hungry
• Tiredness, weakness or dizziness
• Sore tongue
• Cold hands, feet
• Chest pain
• Cracks in the side of the mouth
• Increased infections

Severe symptoms might include:

• Blue-tinged, pale whites of eyes
• Brittle nails
• Pale skin

How to treat anemia

Your health care provider can do a blood test to check for iron deficiency anemia. There can be other causes for the symptoms, so make sure you see your health care provider. Iron deficiency anemia can also strike older children, such as teenage girls who lose blood during menstruation and young men during rapid growth spurts. Teenagers who exercise a lot can lose iron stores. The best way to treat iron deficiency anemia is through healthy, iron-rich foods. These include apricots, chicken, turkey, fish, meats, dried beans, lentils, soybeans, eggs, liver, molasses, oatmeal, peanut butter, prunes, raisins, prune juice, spinach, kale and green vegetables. There can be significant long-term problems if iron deficiency is not corrected. Some of those are:

• Decreased ability to learn
• Decreased concentration, attention span and alertness
• Learning problems
• The body’s absorption of more lead, which can result in learning and behavior problems

In some cases, the health care provider will prescribe iron. Only give the dose recommended by the doctor and give with vitamin C-fortified fruit juice to help the body absorb the iron. Only give iron if prescribed by your health care provider because giving too much iron can lead to poisoning. Make sure you follow and understand the dose ordered for your child.