What is iron deficiency anaemia?
Iron is an important mineral found in the 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.
Iron deficiency in children symptoms
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:
Pale
Tired, lacking energy
Irritable, grumpy, behavioural issues
Poor concentration
Poor appetite
Poor weight gain
Headaches
PICA (this is when your child constantly eats non-food items: dirt, ice, paper etc.)
How do you diagnose iron deficiency anemia
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 levels. The symptoms are often non-specific and can be caused by many things, so proper assessment is essential. Assuming such symptoms are related 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 are low AND the haemoglobin is also low. This is a more severe form and will need longer treatment.
What causes iron deficiency and what can I do to prevent it?
Iron comes from the 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 cow's 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.
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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.
Iron deficiency treatment
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.
Iron Supplements
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, the 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 that 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 supplements with food or at night and increasing the dose gradually.
Over-the-counter multivitamins 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.
Iron Supplements'side effects
Poo turns black or grey
Constipation or abdominal pain
Staining of teeth. Brush your child’s teeth following an iron supplement.
How long does it take for iron supplements to work?
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.
How to get my child to take iron supplements
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 flavour 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 absorption.)
Try adding flavour 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.
Key points of iron deficiency
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 cow's 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 an 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 on iron deficiency in children and ways to your boost iron intake. Please remember to see your GP if you are worried about your child at any time.
Stay well,
Dr Lexi
Xxx
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Disclaimer: The information in this article is provided for educational purposes only and is not intended to substitute advice provided by your doctor or other healthcare professionals. The author of this information has made a considerable effort to ensure the information is in-line with current guidelines, codes and accepted clinical evidence at time of writing, is up-to-date at time of publication and relevant to Australian readers. The opinions and thoughts expressed in this article reflects the view of the author only and not the broader medical profession or her places of work. The author accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in this information. Â We recommend you always consult a qualified health practitioner for individualised advice.
