Iron-deficiency anemia is the most common nutritional deficiency of childhood. Children who fail to receive adequate iron in their diets to support growth and development will develop iron deficiency. Iron is required by the body to produce red blood cells, which carry oxygen through the bloodstream to the tissues.  When children do not have adequate iron, they may become anemic.  Anemia means that the number of red blood cells in the child's body is below normal.

Most children with anemia have no symptoms. However, even asymptomatic anemia can cause subtle developmental delays and decreased school performance. Children with anemia significant enough to cause symptoms may be pale, tired, irritable, feed poorly, and have greater difficulty fighting infections. 

Who is at risk?

• Children whose diet is low in iron are at risk for iron deficiency.
• The highest levels of dietary iron are found in animal proteins. Vegetarians and particularly vegans are at increased risk of iron deficiency.
• Iron is passed from a pregnant mother to her fetus late in pregnancy, so premature infants are at very high risk for iron deficiency and should take an iron supplement for the first year of life.
• Cow’s milk is very low in iron and actually blocks the ability to absorb iron from other foods, so excessive milk intake can also cause iron deficiency.
• Menstruating females lose iron in their menstrual blood with each period, so they are also at risk for iron deficiency.

Prevention

1. Encourage breastfeeding for the first 4-6 months. The iron in breastmilk is in an ideal form to be absorbed by an infant’s body. At 4-6 months, begin iron-fortified cereals.
2. For pre-term infants, supplement with iron drops until 12 months of age.
3. Non-breastfeeding infants should take iron-fortified formulas until 12 months of age.
4. When introducing solids, consider pureed meats, iron-rich foods, and foods with Vitamin C, which increases the body’s absorption of iron.
5. Children age 1-5 years should limit milk intake to 24 ounces per day or less.
6. Limit juice intake and sweets. These decrease a child’s appetite for healthy foods that contain iron.
   

Screening

In the office we routinely check for anemia with a finger-stick test that measures the hemoglobin level (an indicator of the number of red blood cells). These finger sticks are performed at the 1-, 2-, and 3-year-old well visits and yearly again once a girl has started menstruating. We also review each child's dietary history to evaluate risk for iron-deficiency anemia.

Treatment

If we find that a child is anemic, we will provide counseling on an iron-rich diet, which includes meat, fish, poultry, raisins, dried fruits, beans, green peas, sweet potato, peanut butter, and enriched cereals and breads. To absorb iron efficiently, children should also have a serving of fruits high in Vitamin C each day.  Milk does not contain iron, so it is best to limit milk intake to 24 ounces per day or less so that children will have an appetite for iron-rich foods.

In some cases, we may have your child take daily iron supplements for 2 to 4 months to increase his or her iron stores.  Typically we will recheck the child's hemoglobin level 4 to 6 weeks after initiating iron therapy to document an increase in the hemoglobin level.
Our goal is to ensure that each child we care for consumes a healthy, iron-rich diet that will prevent iron-deficiency anemia. If anemia develops, we hope to diagnose and treat it before any harm is done.