Iron-deficiency anemia

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Overview

Iron deficiency anemia is the most common form of anemia in children. A child who is diagnosed with iron deficiency anemia has a decreased number of red blood cells in his or her blood due to a lack of iron. Your body gets iron from certain foods and it recycles iron from old red blood cells. Iron deficiency can be caused by an iron-poor diet; blood loss (even slow loss of small amounts over a long period of time); rapid growth; the body's inability to absorb iron well (even when enough iron is being consumed); or a combination of several of the above.

Red blood cells bring oxygen to body tissues, so having insufficient numbers of red blood cells means that muscles and organs may not have enough oxygen to function fully. Low iron levels in children can cause a decreased attention span, reduced alertness and learning difficulties. Since iron is also used by cells other than blood cells, such as brain cells, low iron can also interfere with brain development in the first years of life.

Children at greatest risk of developing iron deficiency include babies who are born premature (more than three weeks before their due date) or have a low birth weight; babies who drink cow's milk before they turn one; breast-fed babies who don't eat foods containing iron after six months; formula-fed babies who aren't fed iron-fortified formula; children between one and five years old who drink more than 24 ounces of milk a day; adolescent girls, who lose iron during menstruation.

Babies are born with iron stored in their bodies for the first few months of life. However, after six months breast-fed babies need to get iron from additional food sources because of their rapid growth, and because breast milk has low concentrations of iron, even though iron from breast milk is more easily absorbed than the iron found in formula.

Cow's milk is a common cause of iron deficiency. It makes it more difficult for the body to absorb iron from other foods. Cow's milk also can cause small amounts of bleeding in the intestines. And, because it does not contain much iron, if cow's milk is a child's primary source of nutrition, he or she will also not be getting enough iron in the diet.

Iron deficiency anemia most commonly affects babies between the ages of nine and 24 months. All babies should have a screening test for iron deficiency between six and 12 months of age. Premature or low birth weight babies may need to be tested earlier.

Signs & symptoms

In mild cases, iron deficiency anemia doesn't have any signs or symptoms. Other times, signs and symptoms include:

  • Blood in the stool
  • Pale skin
  • Blue-tinted whites of the eyes
  • Decreased appetite
  • Fatigue and/ or weakness
  • Irritability
  • Shortness of breath
  • Sore/ inflamed tongue
  • Behavioral problems
  • Unusual cravings for non-nutritive substances (such as dirt or ice)

Diagnosis

Your child will have a blood sample drawn, which will be sent to a laboratory for examination in order to make a diagnosis. Patients with iron deficiency anemia have smaller and paler red blood cells. Tests of their iron levels and iron stores will be abnormally low, and other tests will indicate that their body is trying to obtain iron by making more of the protein that carries iron in the blood. It is important to distinguish anemia caused by iron deficiency from other causes of anemia which are not iron related.

Treatment

Iron deficient patients are given iron supplements (ferrous sulfate). Iron supplements are best absorbed on an empty stomach, and with acidic juices such as orange juice. Though some people need to take them with food to avoid stomach upset, it is important to know that some foods such as dairy and soy products can interfere with the absorption of iron. Cow's milk can interfere with iron absorption and should not be taken at the same time as iron supplements.

Iron may also be given by injection into a muscle or through a vein (IV).

In most cases, the red blood counts will return to normal after a few months of iron supplementation, although your child may need to continue the supplements for several months after the anemia is gone to build up stores. Your child's doctor will want to determine the cause of the iron deficiency, which may require further investigation.

Diet is an important way to prevent and treat iron deficiency.

Good sources of iron include:

  • Lean meats
  • Dried beans and lentils
  • Eggs
  • Fish
  • Peanut butter
  • Soybeans
  • Iron-fortified breads and cereals
  • Apricots
  • Kale and other greens
  • Oatmeal
  • Prunes
  • Raisins

Vitamin C helps promote the absorption of iron. Iron deficient patients should have a diet that includes foods rich in vitamin C, including: Oranges, melon, strawberries, apricots, kiwi, broccoli and potatoes.

UCSF Benioff Children's Hospitals medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your child's doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your child's provider.

Where to get care

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Hematology Clinic

Hematology Clinic

San Francisco / Oakland / Santa Rosa / Walnut Creek

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