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Iron deficiency anemia - children

Contents of this page:


Red blood cells, target cells
Red blood cells, target cells
Formed elements of blood
Formed elements of blood

Alternative Names    Return to top

Anemia - iron deficiency - children

Definition    Return to top

Iron deficiency anemia is a decrease in the number of red blood cells due to a lack of iron.

This article focuses on iron deficiency anemia in children.

Causes    Return to top

Iron deficiency anemia is the most common form of anemia. Iron is an essential part of hemoglobin, the oxygen-carrying protein in blood. You get iron through certain foods, and your body also reuses iron from old red blood cells.

Babies are born with about 500 milligrams (mg) of iron in their bodies. By the time they reach adulthood they need to have about 5,000 mg.

Children need to absorb an average of 1 mg per day of iron to keep up with the needs of their growing bodies. Since children only absorb about 10% of the iron they eat, most children need to receive 8-10 mg of iron per day. Breastfed babies need less, because iron is absorbed 3 times better when it is in breast milk.

An iron-poor diet is a common cause of iron deficiency. Drinking too much cow's milk is a common cause of iron deficiency in young children because cow’s milk contains little iron and can get in the way of iron absorption. Cow's milk also can cause problems in the intestine that lead to blood loss and increased risk of anemia.

Iron deficiency most commonly affects babies between 9 - 24 months old. All babies should have a screening test for iron deficiency at this age. Babies born prematurely may need to be tested earlier.

The adolescent growth spurt is another high-risk period.

Iron deficiency in children can be related to lead poisoning or slow bleeding.

Symptoms    Return to top

Note: There may be no symptoms if anemia is mild.

Exams and Tests    Return to top

The health care provider will perform a physical exam. A blood sample is taken and sent to a laboratory for examination. Red blood cells appear small when looked at under a microscope.

Specific tests that may be done include:

Treatment    Return to top

Treatment involves iron supplements (ferrous sulfate), which are taken by mouth. The iron is best absorbed on an empty stomach, but many people need to take the supplements with food to avoid stomach upset.

If you cannot tolerate iron supplments by mouth, iron may be given by injection into a muscle or through a vein (IV).

Milk and antacids can interfere with iron absorption and should not be taken at the same time as iron supplements.

Iron supplements are needed during pregnancy and breastfeeding because diet alone rarely supplies the needed amount.

Iron-rich foods include raisins, meats (especially liver), fish, poultry, egg yolks, legumes (peas and beans), and whole-grain bread.

Outlook (Prognosis)    Return to top

With treatment, the outcome is likely to be good. In most cases, the blood counts will return to normal in 2 months.

However, you should continue taking iron supplements for another 6 to 12 months, or as your health care provider recommends. This will help the body rebuild its iron storage.

Iron supplementation improves learning, memory, and cognitive test performance in adolescents who have low levels of iron. Iron supplementation also improves the performance of athletes with anemia and iron deficiency.

Possible Complications    Return to top

Iron deficiency anemia can affect school performance. Low iron levels are an important cause of decreased attention span, reduced alertness, and learning difficulties, both in young children and adolescents.

Prevention    Return to top

Diet is the most important way to prevent and treat iron deficiency.

Good sources of iron include:

Better sources of iron include:

The best sources of iron include:

References    Return to top

Wu AC, Lesperance L, Bernstein H. Screening for iron deficiency. Pediatr-Rev. May 2002;23:171-178.

Glader B. Iron-deficiency anemia. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 455.

Update Date: 12/9/2008

Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine; and Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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