Iron Deficiency Anemia in Children

Iron deficiency anemia is a condition in which the concentration of red blood cells or hemoglobin in the blood is below normal because of too little iron.

Hemoglobin is a substance in red blood cells that carries oxygen to the body’s tissues. When the concentration of red blood cells or hemoglobin is too low, not enough oxygen reaches these tissues. Iron deficiency anemia is usually long-lasting (chronic) and it develops over time. It may or may not cause symptoms.

Iron deficiency anemia is a common type of anemia. It is often seen in infancy and childhood because the body needs more iron during these stages of rapid growth. If this condition is not treated, it can affect growth, behavior, and school performance.

What are the causes?

This condition may be caused by:

• Not enough iron in the diet. This is the most common cause of iron deficiency anemia among children.
• Iron deficiency in a mother during pregnancy (maternal iron deficiency).
• Blood loss caused by bleeding in the intestine (often caused by stomach irritation due to cow’s milk).
• Blood loss from a gastrointestinal condition like Crohn disease or from switching to cow’s milk before 1 year of age.
• Frequent blood draws.
• Abnormal absorption in the gut.

What increases the risk?

This condition is more likely to develop in children who:

• Are born early (prematurely).
• Drink whole milk before 1 year of age.
• Drink formula that does not have iron added to it (formula that is not iron-fortified).
• Were born to mothers who had an iron deficiency during pregnancy.

What are the signs or symptoms?

If your child has mild anemia, he or she may not have any symptoms. If symptoms do occur, they may include:

• Delayed cognitive and psychomotor development. This means that your child’s thinking and movement skills do not develop as they should.
• Fatigue.
• Headache.
• Pale skin, lips, and nail beds.
• Poor appetite.
• Weakness.
• Shortness of breath.
• Dizziness.
• Cold hands and feet.
• Fast or irregular heartbeat.
• Irritability or rapid breathing. These are more common in severe anemia.
• ADHD (attention deficit hyperactivity disorder) in adolescents.

How is this diagnosed?

If your child has certain risk factors, your child’s health care provider will test for iron deficiency anemia. If your child does not have risk factors, iron deficiency anemia may be diagnosed after a routine physical exam. Tests to diagnose the condition include:

• Blood tests.
• A stool sample test to check for blood in the stool (fecal occult blood test).
• A test in which cells are removed from bone marrow (bone marrow aspiration) or fluid is removed from the bone marrow to be examined (biopsy). This is rarely needed.

How is this treated?

This condition is treated by correcting the cause of your child’s iron deficiency. Treatment may involve:

• Adding iron-rich foods or iron-fortified formula to your child’s diet.
• Removing cow’s milk from your child’s diet.
• Iron supplements. In rare cases, your child may need to receive iron through an IV tube inserted into a vein.
• Increasing vitamin C intake. Vitamin C helps the body absorb iron. Your child may need to take iron supplements with a glass of orange juice or a vitamin C supplement.

After 4 weeks of treatment, your child may need repeat blood tests to determine whether treatment is working. If the treatment does not seem to be working, your child may need more testing.

Follow these instructions at home:

Medicines

• Give your child over-the-counter and prescription medicines only as told by your child’s health care provider. This includes iron supplements and vitamins. This is important because too much iron can be poisonous (toxic) to children.
• If your child cannot tolerate taking iron supplements by mouth, talk with your child’s health care provider about your child getting iron through:
  • A vein (intravenously).
  • An injection into a muscle.
• Your child should take iron supplements when his or her stomach is empty. If your child cannot tolerate them on an empty stomach, he or she may need to take them with food.
• Do not give your child milk or antacids at the same time as iron supplements. Milk and antacids may interfere with iron absorption.
• Iron supplements can cause constipation. To prevent constipation, include fiber in your child’s diet or give your child a stool softener as directed.

Eating and drinking

• Talk with your child’s health care provider before changing your child’s diet. The health care provider may recommend having your child eat foods that contain a lot of iron, such as:
  • Liver.
  • Lowfat (lean) beef.
  • Breads and cereals that are fortified with iron.
  • Eggs.
  • Dried fruit.
  • Dark green, leafy vegetables.
• Have your child drink enough fluid to keep his or her urine clear or pale yellow.
• If directed, switch from cow’s milk to an alternative such as rice milk.
• To help your child’s body use the iron from iron-rich foods, have your child eat those foods at the same time as fresh fruits and vegetables that are high in vitamin C. Foods that are high in vitamin C include:
  • Oranges.
  • Peppers.
  • Tomatoes.
  • Mangoes.

General instructions

• Have your child return to his or her normal activities as told by his or her health care provider. Ask your child’s health care provider what activities are safe.
• Teach your child good hygiene practices. Anemia can make your child more prone to illness and infection.
• Let your child’s school know that your child has anemia and that he or she may tire easily.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

How is this prevented?

Talk with your child’s health care provider about how to prevent iron deficiency anemia from happening again (recurring).

• Infants who are premature and breastfed should usually take a daily iron supplement from 1 month to 1 year old.
• If your baby is exclusively breastfed, he or she should take an iron supplement starting at 4 months and until he or she starts eating foods that contain iron. Babies who get more than half of their nutrition from breast milk may also need an iron supplement.
• If your baby is fed with formula that contains iron, his or her iron level should be checked at several months of age and he or she may need to take an iron supplement.

Contact a health care provider if:

• Your child feels weak or nauseous or vomits.
• Your child has unexplained sweating.
• Your child develops symptoms of constipation, such as:
  • Cramping with abdominal pain.
  • Having fewer than three bowel movements a week for at least 2 weeks.
  • Straining to have a bowel movement.
  • Stools that are hard, dry, or larger than normal.
  • Abdominal bloating.
  • Decreased appetite.
  • Soiled underwear.

Get help right away if:

• Your child faints.
• Your child has chest pain, shortness of breath, or a rapid heartbeat.
• Your child gets light-headed when getting up from sitting or lying down.