Iron deficiency anemia - children

Alternative names
Anemia - iron deficiency - children

Definition
Iron deficiency anemia is a decrease in the number of red blood cells, caused by a lack of sufficient iron.

Causes, incidence, and risk factors

Iron deficiency anemia is the most common form of anemia. Iron is an essential component of hemoglobin, the oxygen-carrying protein (pigment) in blood. Iron is normally obtained in the diet and by the recycling of iron from old red blood cells.

Babies are born with about 500mg of iron in their bodies. By the time they reach adulthood they need to have accumulated about 5000mg.

Children need to absorb an average of 1mg 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 ingest 8-10mg per day of iron. Breast-fed babies need less, because iron is absorbed 3 times better when it is in breast milk.

Drinking too much cow’s milk is a classic cause of iron deficiency in young children.

A common time for iron deficiency is between 9 and 24 months of age. 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 also be related to lead poisoning.

Symptoms

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

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

Signs and tests

     
  • Low hematocrit and hemoglobin (red blood cell measures)  
  • Small red blood cells  
  • Low serum ferritin (serum iron) level  
  • High iron binding capacity (TIBC) in the blood  
  • Blood in stool (visible or microscopic)

Treatment

Oral iron supplements are in the form of ferrous sulfate. Iron supplements are best absorbed on an empty stomach, but many people are unable to tolerate them and may need to take them with food. Milk and antacids may interfere with absorption of iron and should not be taken at the same time as iron supplements. Vitamin C can increase absorption and is essential in the production of hemoglobin.

Supplemental iron is needed during pregnancy and lactation because normal dietary intake rarely supplies the required amount.

The hematocrit should return to normal after 2 months of iron therapy, but iron supplements should be continued for another 6 to 12 months. This will replenish the body’s iron stores, contained mostly in the bone marrow.

Intravenous or intra-muscular iron is available for patients who can not tolerate oral iron supplements.

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

Iron supplementation significantly improves learning, memory, and cognitive test performance in iron-deficient adolescents. Iron supplementation also measurably improves the performance of iron-deficient, anemic athletes.

Expectations (prognosis)

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

Complications

Iron deficiency (even when not enough to cause anemia) is an important cause of decreased attention span, alertness, and learning - both in young children and in adolescents. Iron deficiency anemia measurably worsens school performance.

Prevention

The child’s diet is the most important way to prevent and to treat iron deficiency. Many foods are good sources of iron:

     
  • Good - Tuna, oatmeal, apricots, raisins, spinach, kale, greens, prunes.  
  • Better - Eggs, meat, fish, chicken, turkey, soybeans, dried beans, peanut butter, peas, lentils, molasses.  
  • Best - Breast milk (the iron is very easily used by the child), formula with iron, infant cereals, other iron-fortified cereals, liver, prune juice.

In addition, restrict milk to no more than 32 ounces daily. If the diet is deficient in iron, iron should be taken orally. During periods of increased requirements, such as teen pregnancy and lactation, increase dietary intake or take iron supplements.

Johns Hopkins patient information

Last revised: December 7, 2012
by Sharon M. Smith, M.D.

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