August 10, 2020
Iron Deficiency in Children
WHAT IS IRON DEFICIENCY and IRON DEFICIENCY ANAEMIA?
Iron is an important mineral found in blood that helps carry oxygen around the body. Iron deficiency anaemia is when the blood cannot carry enough oxygen because iron levels are too low. Iron is essential in providing energy for daily life as well as being vital for brain development.
HOW CAN I TELL IF MY CHILD IS IRON DEFICIENT?
It is important to see your doctor if you think your child may be iron deficient. Some things to look out for are if your child is:
Tired, lacking energy
Irritable, grumpy, behavioural issues
Poor weight gain
PICA (this is when your child constantly eats non-food items: dirt, ice, paper etc.)
Iron Deficiency in children is very common and can only be diagnosed by a blood test. We usually test iron stores (ferritin) and full blood examination (FBE) looking at haemoglobin level. The symptoms are often non-specific and can be caused by many things, so proper assessment is essential. Assuming such symptoms relate to iron deficiency can lead to other issues being missed.
Without intervention, a child whose diet does not provide them with enough iron will eventually develop iron deficiency anaemia.
Iron deficiency is where the iron stores (ferritin) are low on a blood test but the haemoglobin (Hb) is normal. Iron deficiency anaemia is where the iron stores is low AND the haemoglobin is also low. This is a more severe form and will need longer treatment.
WHY IS MY CHILD IRON DEFICIENT and WHAT CAN I DO TO PREVENT IT?
Iron comes from foods we eat. Iron deficiency is usually caused by your baby/child not getting enough iron in his diet. Children are at higher risk of iron deficiency than adults, mainly because children need more iron when they go through growth spurts.
In babies, iron deficiency might happen if your baby is exclusively breastfed or formula fed beyond six months of age. By this age, your baby has used up all the iron stores they built up when they were in the womb and breast milk/formula alone is a poor source of iron. This is one of the reasons we recommend you commence your child on solids between 4-6 months of age and include iron rich foods.
Babies who are born prematurely, who were very sick as newborns or whose mothers were iron deficient in late pregnancy are also at risk of iron deficiency. Most premature babies need iron supplements in the first months of life, because they did not get enough transferred during pregnancy. Most of the iron transfer from mother to baby happens late in the third trimester.
In toddlers, iron deficiency may be caused by not having enough iron rich foods in their diet (vegans, vegetarians, fussy eaters) or if your child drinks too much cows milk, as milk stops the iron in food from being absorbed properly. Cows milk may also fill your child up and reduce their appetite for other foods.
We recommend cows milk be introduced > 12 months of age. Prior to 12 months, only breast milk or formula should be used. By 12 months of age, your infant should be predominantly dependent on solid foods, with the amount of milk/formula less than 500 ml per day.
Other causes of iron deficiency in children such as coeliac disease (which stops your child from absorbing iron from food well) or gastrointestinal blood loss are much less common.
HOW DO I TREAT IT?
Once your child is diagnosed with iron deficiency or iron deficiency anaemia on a blood test, your doctor will recommend dietary changes as well as iron supplementation.
Diet – Add Iron-rich Foods
Good sources of iron include red meat, chicken, fish, legumes e.g. lentils and beans, egg yolks, wholegrain and iron fortified cereals, and dark green leafy vegetables e.g. spinach, and crushed sesame seeds e.g. tahini.
Foods containing Vitamin C improve the absorption of iron so try to include foods such as fruits (oranges, mandarins, berries, kiwi fruit, strawberries) and vegetables (capsicum, tomato, broccoli, cabbage) in your child’s diet.
In most children, your doctor will recommend treating iron deficiency with ORAL iron supplements. This should always be done with medical supervision.
Oral iron comes in liquid or tablet/spansule/capsule forms.
In Australia, most common syrups recommended are Ferro-liquid or Maltofer syrup. Other forms recommended for children may be FeFol spansules (iron and folate mini capsules that open up and the beads can be sprinkled on food) or tablets which contain iron (Ferro-gradumet, Ferro-grad C, Ferro-tab, FGF, Maltofer) in older children.
Iron is better absorbed if taken with Vitamin C (e.g. orange juice) so it is recommended your child should have Vitamin C daily if on oral supplements.
Iron supplements are usually given 1 hour before or 2 hours of food but if tummy upset occurs, this can be reduced by taking supplement with food or at night and increasing the dose gradually.
Over the counter multi-vitamin or mineral supplements DO NOT contain sufficient iron content to treat iron deficiency. Adequate doses of iron need to be given if your child is diagnosed with iron deficiency.
It is very rare for a child to need an iron infusion (intravenous iron) and this should only be done in consultation with a paediatrician or haematologist. Iron infusions have significant risks associated with them in children.
SIDE EFFECTS OF IRON SUPPLEMENTATION
Poo turns black or grey
Constipation or abdominal pain
Staining of teeth. Brush your child’s teeth following iron supplement.
HOW LONG DO I NEED TO TREAT IT FOR?
Iron supplements should be continued for a minimum of 3 months after iron deficiency or anaemia has been corrected. Your child may need a repeat blood test to check they have responded to iron supplements. If they are not improving, your doctor may need to look for other reasons your child may be iron deficient and your child may be referred to see a paediatrician or paediatric haematologist.
WHAT IF I CAN’T GET MY CHILD TO TAKE ORAL IRON?
Getting your child to take daily iron supplements can be challenging. Iron supplements do tend to taste metallic (iron is a metal) so some children will try to avoid taking them.
Suggestions to help your child take iron:
Add to food - try and mask the flavor of your liquid iron supplement by using apple sauce, fruit or vegetable purees or mixing it in a liquid e.g. orange juice. Avoid mixing it with yoghurt or milk type products as it can limit the absorption.
Try adding flavor to liquid or hiding beads of spansules in food.
IT IS WORTH PERSISTING, EVEN IF IT IS DIFFICULT as iron is so important for your child.
Start solid foods, containing iron, from around 4-6 months of age
Breast milk or infant formula should be your baby’s main drink until 12 months of age
Include Vitamin C-rich foods to help the absorption of iron
Limit cows milk to < 500 ml per day from 12 months of age
If you are concerned that your child may be iron deficient, see your doctor and have a blood test to diagnose it
Avoid the temptation to self-diagnose and give your child over the counter iron supplements because overdose of iron is extremely dangerous and can cause death
Treatment will include both dietary sources of iron and ORAL iron supplementation
ALL IRON SUPPLEMENTS SHOULD BE STORED IN A LOCKED CUPBOARD AWAY FROM CHILDREN.
Below are some great local resources you can access any time:
Please remember to see your GP if you are worried about your child at any time.
Disclaimer: This information is intended to support, not replace, discussion and consultation with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. Mama You've Got This and Dr Lexi Frydenberg accept no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in this information.
Mama You've Got This
Dr Lexi Frydenberg