Ed Uthman

Iron Deficiency Anemia in Children

Brain & Nerve
Digestive Health
Contributed byKrish Tangella MD, MBAOct 17, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • IDA in Children
  • Paediatric IDA
  • Pediatric Iron Deficiency Anemia

What is Iron Deficiency Anemia in Children? (Definition/Background Information)

  • Iron deficiency is the most common nutrition-related disorder in the world. It can cause anemia and other health effects
  • Iron Deficiency Anemia in Children is a common type of anemia in which the level/quantity of red blood cells (RBCs) in blood is low and the size of the red blood cell becomes smaller, due to decreased iron stores in the body
  • Iron is an essential component of hemoglobin, which is present in the RBCs. Hemoglobin, carries oxygen from the lungs to the tissues. Without iron, both hemoglobin and RBC levels become low in blood, meaning that less oxygen reaches the cells and tissues; this interferes with the ability of cells and tissues to function properly
  • One of the most common causes of Iron Deficiency Anemia in Children is inadequate dietary iron; the iron quantity consumed through food does not meet the needs of the body
  • Pediatric Iron Deficiency Anemia is often treatable. However, the first step is to determine the cause, as to why the child has deficient levels of iron
  • The treatment would involve iron-rich diet and iron supplementation. With proper treatment the prognosis of Iron Deficiency Anemia in Children is good

Who gets Iron Deficiency Anemia in Children? (Age and Sex Distribution)

  • Children between 9 and 24 months old are at high risk for iron deficiency and anemia. Iron deficiency is seen in nearly 10% of this age group children
  • Boys and girls can both be affected by iron deficiency anemia; however, adolescent girls are at higher risk because of the loss of iron in blood during their menstrual periods
  • Pediatric Iron Deficiency Anemia is a global problem; all racial and ethnic groups are affected. It is reported that almost 30% of the global population have iron deficiency anemia, especially in the developing countries

What are the Risk Factors for Iron Deficiency Anemia in Children? (Predisposing Factors)

Children at risk for iron deficiency anemia due to various reasons include:

  • Premature or low-birth weight babies are at risk because they do not have sufficient iron stores, when compared to full-term and normal weight babies
  • Infants, under 12 months, who drink cow’s milk are also at risk. Cow’s milk does not have sufficient iron needed for normal development in comparison to breast milk or iron-fortified formula
  • Infants older than 6 months of age who are solely breast-fed, without any iron-fortified solid foods to supplement breast milk are at risk
  • Infants, solely feeding on mother’s milk, who themselves have low iron stores
  • Children, aged 1-5 years, who drink more than 24 ounces (over 700ml) of cow’s milk, are at risk for Pediatric Iron Deficiency Anemia
    • Cow’s milk reduces the absorption of iron
    • Cow’s milk can also irritate the lining of the gastrointestinal tract (bovine milk-induced enteropathy), possibly leading to the loss of small amounts of blood, thus further contributing to iron loss from the body
  • Adolescent girls are at risk for developing iron deficiency and anemia, because they lose iron in blood during their menstrual periods
  • Vegetarians are at risk of developing iron deficiency anemia, if they do not consume foods rich in iron to compensate for the lack of meat in their diets

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Iron Deficiency Anemia in Children? (Etiology)

The cause of Iron Deficiency Anemia in Children includes:

  • In developed countries, the most common cause of iron deficiency anemia is excess consumption of cow’s milk, which is low in iron content. Cow’s milk can also cause blood loss (loss of iron) due to milk protein colitis (inflammation of the large intestine). Children affected by this condition are usually overweight
  • Blood loss should be considered in every child with iron deficiency anemia. Blood loss can occur due to:
    • Heavy menstrual periods
    • Gastrointestinal conditions such as peptic ulcer, Meckel diverticulum, hemangioma, and inflammatory bowel disease
    • Drinking large quantities of cow’s milk, which may cause a loss of blood (exposure to heat labile protein)             
  • In developing countries, infections with hookworm, Helicobacter pylori, or Trichuris trichura can be a cause of iron deficiency anemia
  • Inadequate iron levels in diet: Consuming too little dietary iron can lead to iron deficiency
  • Poor absorption of iron: Iron is normally absorbed into the bloodstream through the small intestine. An abnormality affecting the body’s ability to absorb nutrients, such as iron from food, can result in iron deficiency anemia
  • Growth spurts: Children and teens require higher amounts of iron during periods of rapid growth spurt

What are the Signs and Symptoms of Iron Deficiency Anemia in Children?

Many children with iron deficiency may be asymptomatic. The signs and symptoms of Iron Deficiency Anemia in Children vary, depending on the hemoglobin levels measured in blood. It includes:

  • Pallor (pale palm, nail bed, and conjunctiva): The most important sign of iron deficiency, which is usually noted by others (not parents). Parents do not usually notice it, because pallor comes on gradually
  • Irritability, headache
  • Anorexia
  • Lethargy, extreme fatigue
  • Poor appetite
  • Sore tongue
  • Brittle nails
  • Dizziness or lightheadedness
  • Congestive heart failure signs and symptoms, such as shortness of breath, fast heartbeat, cold hands and feet, or murmur, may manifest when anemia is advanced

Some symptoms that are not directly related to anemia may appear, even before anemia becomes evident. These include:

  • Impairment in intellectual functioning, behavioral problems
  • Problems with motor functioning (example hand or leg movement)
  • Pica: A desire to eat substances that are non-food items such as hair, dirt, paper, or starch
  • Pagophagia: A desire to eat ice

How is Iron Deficiency Anemia in Children Diagnosed?

Iron Deficiency Anemia in Children may be diagnosed as follows:

  • Complete blood count (CBC): This measures the red blood cell count and hemoglobin levels in blood. Low levels of hemoglobin and/or RBC count can indicate iron deficiency
    • This test can also provide information on the size of RBCs, which appear smaller with iron deficiency anemia. The smaller RBCs seen in iron deficiency anemia are microcytic or low MCV (mean corpuscular volume) and hypochromic (pale)
    • Reticulocyte distribution width (RDW) is high in iron deficiency anemia, which means that the red blood cells have variable sizes           
  • Hematocrit test to determine the percentage of total blood volume comprised by red blood cells (the other components being plasma, water, proteins, etc.)
  • Blood tests to check iron stores in the body, which include:
    • Serum ferritin: Ferritin is a protein located in cells that store iron. Serum ferritin tests measure the amount of ferritin in blood, which also indicates the levels of iron stored in the body. Serum ferritin is low in iron deficiency anemia
    • Serum iron: A test that directly measures the amount of iron in blood
    • TIBC (total iron-binding capacity) of the serum: Increase in transferrin is seen with iron deficiency anemia
  • Stool test for occult blood: This test is used to check if there is bleeding in the gastrointestinal tract, which can be a source of iron loss and hence, iron deficiency anemia

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Iron Deficiency Anemia in Children?

The possible complications of Iron Deficiency Anemia in Children are:

  • Iron deficiency can affect academic performance - inadequate iron levels can contribute to decreased attention span and problems with learning
  • Iron deficiency is associated with delayed growth and development, as well as with a higher risk for infections
  • Iron deficiency may cause some children to eat non-food items, such as lead-containing objects, ultimately resulting in lead poisoning
  • Congestive heart failure

How is Iron Deficiency Anemia in Children Treated?

It is important to determine the cause of the iron deficiency anemia so that the appropriate treatment is provided. The most common cause is inadequate intake of iron through the diet.

Iron Deficiency Anemia in Children is treated using the following measures:

  • Use of iron supplements: Iron tablets may be recommended to replenish the body’s depleted iron supply
    • Iron tablets (ferrous sulphate) are absorbed most effectively when taken on an empty stomach; best absorbed when taken between meals. However, some children may experience an upset stomach, in which case iron supplements may need to be taken with small amounts of food or juice
    • Taking iron tablets with vitamin C, such as orange juice, or vitamin C supplements, helps to increase the absorption of iron in the body
    • Iron supplements should not be taken with milk or beverages containing caffeine, as these can decrease the body’s ability to absorb iron
    • Iron supplements will most likely need to be taken for several months in order to correct the deficient iron levels
    • After the first month or two of taking iron supplements, the healthcare provider may repeat blood tests to determine if there is good response to treatment. Iron supplements may be discontinued then. This response to iron therapy is also diagnostic, meaning that it confirms the original diagnosis of iron deficiency anemia
    • Iron injections: It is used when children cannot tolerate oral iron tablets, or if taking the tablet as prescribed, becomes an issue       
  • Iron-rich diet: Along with iron tablets, eating foods rich in iron that include meats, spinach, eggplant, dried fruits, poultry, eggs, and iron-fortified cereals is beneficial
  • Blood loss treatment: The healthcare provider may suggest suitable treatment measures to stop blood loss. Birth control pills may be prescribed for adolescent girls to regularize their menstrual flow
  • Avoidance of factors that cause Iron Deficiency Anemia, such as avoiding giving infant's cow’s milk, before they complete 12 months of age
  • Treatment of the underlying cause such as gastritis or bleeding ulcer
  • Blood transfusions: In very rare cases, if there is continuous blood loss, or if iron deficiency anemia becomes severe enough to cause the heart to fail, blood transfusions may be performed. Blood transfusions can help quickly provide red blood cells that the body can use immediately

How can Iron Deficiency Anemia in Children be Prevented?

Preventative measures that can be taken to prevent Iron Deficiency Anemia in Children are as follows:

  • Eating iron-rich foods such as:
    • Dark green leafy vegetables (broccoli, spinach)
    • Legumes such as beans and peas
    • Dried fruits (raisins, apricots)
    • Iron-fortified cereals, pastas, and breads
    • Poultry (chicken, duck, turkey, etc.) and eggs           
    • Meats (beef, pork, lamb, liver, etc.)
    • Fish and seafood
    • Molasses
    • Baby formula with iron
    • Breastmilk
    • Prune juice
  • Infants should be fed with breast milk or iron-fortified formula for at least the first 12 months - it is not recommended to give cow’s milk to infants under 12 months, as it is a poor source of iron
  • For vegetarians, it is important to increase the consumption of iron-rich, plant-based foods to compensate for the lack of iron through meat
  • Delayed clamping of cord (during birth of a child) can help improve iron stores in the infant
  • Periodic health exams and blood tests (if suggested by the healthcare provider) can help in preventing Iron Deficiency Anemia in Children

What is the Prognosis of Iron Deficiency Anemia in Children? (Outcomes/Resolutions)

  • With treatment, the prognosis for Iron Deficiency Anemia in Children is usually good. Typically, blood counts return to normal within a few months following treatment
  • Iron supplements will still need to be taken for 6-12 months, to replenish iron stores in the body; following this, an iron-rich diet can help maintain healthy iron levels in the body

Additional and Relevant Useful Information for Iron Deficiency Anemia in Children:

  • An Iron Blood Test determines the quantity of iron that is free-floating in the serum

The following article link will help you understand an iron blood test:


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