Iron deficiency anemia is a prevalent nutritional disorder among children worldwide, characterized by a deficiency in iron that leads to reduced hemoglobin levels in the blood. This condition can significantly impact a child’s growth, development, and overall health.
Iron is a crucial mineral necessary for the production of hemoglobin, the protein in red blood cells responsible for carrying oxygen throughout the body. Without sufficient iron, children may experience symptoms such as fatigue, weakness, pale skin, and developmental delays.
Understanding the causes, symptoms, and effective prevention strategies of iron deficiency anemia is essential for parents and caregivers to ensure their children’s optimal health and well-being.
What is Iron?
Iron is a mineral our bodies need to make hemoglobin, a protein in red blood cells that carries oxygen from the lungs to the rest of the body. Another important protein, called myoglobin, is found in our muscles. Myoglobin helps transport and store oxygen in the muscles.
Iron deficiency can happen in three stages:
Iron depletion: At this stage, your hemoglobin levels are normal, but your iron stores are low. This can be tricky because it’s the beginning stage, and it doesn’t always mean you’ll become iron deficient.
Iron deficiency: Here, both your hemoglobin and iron levels are low. Most people discover they don’t have enough iron at this stage.
Iron deficiency anemia: This is the most serious stage. Hemoglobin and iron levels are very low, and there isn’t enough hemoglobin to carry oxygen around the body. If your child reaches this stage, you need to go to the hospital immediately for treatment.
What is Iron-Deficiency Anemia in Children?
Iron-deficiency anemia is a condition where a child lacks enough iron to produce hemoglobin, the protein in red blood cells responsible for carrying oxygen throughout the body. This deficiency can lead to various health issues, impacting growth, development, and overall well-being.
The prevalence of iron deficiency varies greatly according to host factors: age, gender, physiological state.
Age
Full-term infants are usually born with enough iron stored in their liver and blood-making tissues because their fetal red blood cells break down soon after birth. This breakdown helps deposit iron in these tissues, especially if the umbilical cord is cut after it stops pulsating.
Breast milk has relatively low iron levels, but the iron it does have is better absorbed than the iron in cow’s milk. Iron deficiency often develops after six months of age if complementary foods don’t provide enough absorbable iron, even for infants who are exclusively breastfed.
Iron needs are linked to growth rate. Therefore, besides women of childbearing age who lose iron due to menstruation, iron deficiency is most common in young children and teenagers due to their rapid growth. Another peak in iron deficiency can occur in old age, when diet quality and quantity often decline.
Gender
Gender can be a factor in causing iron deficiency anemia, especially for adolescent girls. After they start menstruating, teenage girls often don’t get enough iron in their diet to make up for the blood loss during their periods. This can lead to a higher risk of iron deficiency anemia during their teenage years.
Physiological State
During pregnancy, a lot of iron is transferred to the placenta and fetus, increasing the need for about 700-850 mg of iron. Although iron absorption improves during pregnancy because menstruation stops, pregnant women often still don’t absorb enough extra iron, raising the risk of iron deficiency.
Breastfeeding also causes iron loss through breast milk. Therefore, women who develop an iron deficiency during pregnancy may continue to have low iron levels while breastfeeding. However, the lack of menstruation during breastfeeding (lactational amenorrhea) helps balance out the iron lost through breast milk.
What causes iron-deficiency anemia in a child?
Iron-deficiency anemia can be caused by:
Diets low in iron:
- A child gets iron from the food in his or her diet. But, only a small amount of the iron in food is actually absorbed by the body.
- Full-term newborns, born to healthy mothers, have iron that they get during the last 3 months of pregnancy.
- Infants of mothers with anemia or other health problems may not have enough iron stored. And infants born early may not get enough iron.
- At 4 to 6 months of age, the iron stored during pregnancy is at a low level. And more iron is used as the infant grows.
- The American Academy of Pediatrics (AAP) advises feeding your baby only breastmilk for the first 6 months. But breastmilk does not have a lot of iron, so infants that are breastfed only, may not have enough iron.
- Older infants and toddlers may not get enough iron from their diets.
Body changes:
When the body goes through a growth spurt, it needs more iron for making more red blood cells.
Gastrointestinal tract problems:
Poor absorption of iron is common after some forms of gastrointestinal surgeries. When you eat foods containing iron, most of the iron is absorbed in the upper small intestine. Any abnormalities in the gastrointestinal (GI) tract could alter iron absorption and cause iron-deficiency anemia.
Blood loss:
Loss of blood can cause a decrease of iron. Sources of blood loss may include gastrointestinal bleeding, menstrual bleeding, or injury.
Symptoms
These are the most common symptoms of iron-deficiency anemia in children:
- Low hemoglobin (fingerstick is done at the doctor’s office)
- Not growing normally
- Motor and cognitive impairments
- Pale skin
- Irritability or fussiness
- Lack of energy or tiring easily (fatigue)
- Fast heart beat
- Sore or swollen tongue
- Spoon shaped nails
- Thin sparse hair
- Wanting to eat odd substances, such as sand or ice etc (also called pica)
Diagnosis
In most cases, anemia is diagnosed with simple blood tests. Routine anemia screening is done because anemia is common in children and they often have no symptoms.
- The AAP recommends anemia screening with a hemoglobin blood test for all infants at 12 months of age.
- The screening should also include a risk assessment. This is a group of questions to find risk factors for iron-deficiency anemia. Risk factors include feeding problems, poor growth, and special healthcare needs.
- If the hemoglobin level is low, more blood tests are done.
- If your child has a risk factor at any age, blood tests are done.
- Blood tests for anemia may also be done during routine physical exam or checkups in children of any age.
Most cases of anemia in children are diagnosed through these blood tests:
- Hemoglobin and hematocrit: This is often the first screening test for anemia in children. It measures the amount of hemoglobin and red blood cells in the blood.
- Complete blood count (CBC): A complete blood count checks the red and white blood cells, blood clotting cells (platelets), and sometimes, young red blood cells (reticulocytes). It includes hemoglobin and hematocrit and more details about the red blood cells.
- Peripheral smear: A small sample of blood is examined under a microscope. Blood cells are checked to see if they look normal or not.
- Iron studies: Blood tests can be done to measure the amount of iron in your child’s body.
The Importance of Iron in the Body
Iron is essential for:
- Producing hemoglobin, which carries oxygen to tissues.
- Supporting cognitive development and function.
- Maintaining a healthy immune system.
Promoting energy production and muscle function.
Types of Iron: Heme vs. Non-Heme
- Heme Iron: Found in animal-based foods like meat, poultry, and fish. It is more easily absorbed by the body.
- Non-Heme Iron: Found in plant-based foods like beans, lentils, and spinach. It is less easily absorbed but can be enhanced with certain dietary practices.
Recommended Daily Iron Intake
- Infants (7-12 months): 11 mg
- Toddlers (1-3 years): 7 mg
- Children (4-8 years): 10 mg
- Older children (9-13 years): 8 mg
- Teen boys (14-18 years): 11 mg
- Teen girls (14-18 years): 15 mg
To get enough iron in your diet, it’s important to include a variety of iron-rich foods. These are divided into three categories:
- Heme Iron Rich Foods: These come from animal sources and include beef, liver, chicken, and seafood. Heme iron is easier for your body to absorb.
- Non-Heme Iron Rich Foods: These come from plant sources and include leafy green vegetables (like spinach and kale), whole grains, legumes (like beans and lentils), seeds (such as pumpkin seeds), and nuts (like cashews and peanuts). Non-heme iron is not as easily absorbed as heme iron, but eating foods high in vitamin C (like citrus fruits) can help improve absorption.
- Foods with Both Heme and Non-Heme Iron: Some foods, like eggs and dairy products, provide good amounts of heme iron, but they don’t contain non-heme iron. Dairy also has calcium, which can affect iron absorption.
Including a mix of these foods in your diet ensures you get enough iron and helps your body absorb it effectively.
Non-heme food sources
- Eggs (mostly the yolk)
- Spinach
- Sweet potato
- Broccoli
- Kale
- Strawberries
- Watermelon
- Dates
- Prunes/prune juice
- Bran cereal
- Oat cereal
- Legume pasta
- Tofu
- Beans (kidney, white beans)
- Peas
- Lentils
Heme iron sources
- Meat
- Liver
- Beef
- Ham
- Turkey
- Chicken
- Pork
- Eggs (primarily in the yolk)
- Seafood
- Shrimp
- Tuna
- Sardines
- Mackerel
Vitamin C-rich food sources
Adding vitamin C-rich foods to iron-rich foods improves their absorption rate (this is especially important for non-heme iron sources, including fortified foods.)
- Strawberries
- Citrus fruits (lemon, lime, grapefruit, oranges)
- Kiwi
- Papaya
- Guava
- Tomato (including tomato sauces)
Creative Ways to Incorporate Iron into Meals
- Adding a variety of veggies in your diet.
- Add nuts and seeds in your smoothies or use them to bake.
- Include wholegrain cereals for breakfast.
- Make meatballs or burgers with ground beef or turkey.
- Add spirulina in meals.
Special Considerations
- Monitoring for signs of iron overload in children on iron supplements.
- Ensuring a balanced diet that meets overall nutritional needs.
- Consulting a healthcare provider for personalized advice and treatment plans.
Iron-Rich Recipes
Beef and Spinach Stir-Fry
Ingredients: Beef strips, fresh spinach, bell peppers, soy sauce, garlic, ginger.
Instructions: Sauté beef with garlic and ginger, add bell peppers, and finish with spinach and soy sauce.
Lentil Soup
Ingredients: Lentils, carrots, celery, tomatoes, onion, garlic, vegetable broth.
Instructions: Sauté onions and garlic, add vegetables, lentils, and broth, and simmer until lentils are tender.
Chickpea and Spinach Curry
Cook chickpea with tomatoes, spinach, onions and a blend of spices e.g cumin and coriander. This curry is not only hearty but also packed with plant based iron and flavors.
Wholegrain Cereal with Almond
Choose any cereal of choice and top it with almond along with your choice of milk or milk alternative. This easy breakfast option is a quick way to boost your iron intake.
Turkey and Sweet Potato Chili
Cook ground turkey, sweet potatoes, beans and tomatoes in a chili sauce. This dish is filling and rich in iron, perfect for dinner.
Frequently Asked Questions
What are the best sources of iron for picky eaters?
If you have a picky eater at home struggling with some of the more common “iron-rich foods” like meat, beans, and legumes, you’re not alone! Many picky eaters often refuse meat, it can have a tough texture. If you struggle with a picky eater, meet them where they are while you work on changes. Many traditional breakfast foods are great for picky eaters (toddlers & kids).
These are some iron-rich foods for picky eaters that are commonly accepted. Pairing these foods with vitamin C-rich foods will help the body absorb more of the iron.
- Chicken nuggets
- Eggs (can be prepared in different forms – Scrambled, hard-boiled, or an egg sandwich are all great options)
- Muffins made with seeds/beans/legumes.
- Peanut butter (you can add this to so many things, toast/bread, chickpea crackers, smoothies, waffles, etc.)
- Pasta (especially whole grain pasta or legume pasta.) Adding spaghetti sauce (rich in vitamin C) will boost iron absorption.
- Whole grain toaster waffles with peanut butter.
- Iron-fortified breakfast cereals e.g oatmeal.
- Seeds (flax, hemp, and chia seeds) are easy to stir into oatmeal, cereal, muffins, pancakes, etc.)
Can too much iron be harmful?
Yes, excessive iron can lead to toxicity. Always follow healthcare provider recommendations.
How long does it take to correct iron deficiency?
It can take a few months of dietary changes and/or supplementation to restore normal iron levels.
By following this guide, parents can better understand iron-deficiency anemia in children and take steps to ensure their kids get enough iron to support their growth and development.
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