Iron is an important dietary mineral that is involved in various functions, especially the transport of oxygen in the blood. This is essential in providing energy for daily life and for brain development. Babies, toddlers, preschoolers and teenagers are at higher risk of iron deficiency, mainly due to increased iron needs during rapid growth periods. A child whose diet does not provide them with enough iron will eventually develop iron-deficiency anemia. There are several major risk factors for the development of iron deficiency in children, including prematurity and low birth weight, exclusive breastfeeding beyond six months (not introducing solids), high intake of cow’s milk in young children less than two years of age, low or no meat intake, generally poor diet in the second year of life, certain gastrointestinal diseases, and the presence of lead poisoning.
The signs and symptoms of iron deficiency anemia in children may include one or more of the following:
- pale skin
- behavioral problems
- increase likelihood of infections
- loss of appetite
- fatigue or weakness
- slow cognitive and behavioral development
- strange ‘food’ cravings (pica) like eating dirt
- failure to grow at the expected rate
Until about six months of age, babies rely on their iron stores from their mother’s uterus. This is another reason why the mother’s diet during pregnancy is so important. Low birth weight or premature babies are at increased risk of iron deficiency and may need iron supplements under the careful supervision of a physician. Between ages six months to one year, a baby’s iron stores begin to run low. Iron deficiency can result if their diet does not include enough iron-rich solid food. At around six months, plain pureed meats can be offered with other solids. Late introduction of solids into the baby’s diet is a common cause of iron deficiency in this age group.
Breast milk contains a small amount of iron, but prolonged and exclusively breastfeeding (after age 1) can lead to iron deficiency, especially if breast milk replaces solid foods in the diet. Low-iron milks such as cow’s milk, goat’s milk and soy milk should not be given until 18 months of age. Adolescent girls are at risk because of several factors, including growth spurts at puberty, iron loss during menstruation, and sometimes due to restricting their own diet.
Some suggestions to prevent iron deficiency in babies less than 12 months of age include:
- Have an iron-rich diet during pregnancy. Red meat, liver, clams/oysters, green leafy vegetables and beans and peas are all good sources of iron.
- If your doctor prescribes iron supplements, take them only according to instructions.
- Breastfeed your baby or choose iron-fortified infant formulas.
- Don’t give cow’s milk or other fluids that may displace iron-rich solid foods before 12 months
- Start giving your baby pureed foods when they are around six months of age.
To prevent iron deficiency in toddlers and preschoolers:
- Include lean red meat three to four times a week. Offer meat alternatives such as beans, lentils, chickpeas, poultry, fish and eggs.
- Include vitamin C as this helps the body to absorb more iron. Citrus fruits and green leafy veggies are rich in vitamin C (think oranges, lemons, berries, kiwifruit, tomatoes, cabbage, capsicum and broccoli)
- Encourage solid foods and take care that toddlers are not ‘filling up’ on drinks between meals.
To prevent iron deficiency in teenagers:
- Talk to your child about the importance of iron. Help them become informed enough to make their own responsible food choices.
- Encourage iron-rich foods and meals. Encourage only moderate amounts of tea and coffee, as these can interfere with iron absorption.
It is important that you see your doctor if you suspect your child may be iron deficient. The diagnosis includes physical examination, medical history and blood tests to exclude other illnesses that can have similar symptoms.