December 11, 2017
ARTICLE:

Iron deficiency

By Dr Megan Yap - Paediatrician

Well hello again everyone!

So today I thought I’d let you guys know about iron deficiency in children.  Quite a few bloggees recently requested the topic and I thought that it was a good “meaty” topic to bite into (ha ha!! Sorry… I seriously cannot help myself).

Iron is a really important mineral that is responsible for VITAL body functions. 

This explanation could get really complicated BUT basically, iron is needed for the body to make:

  1. Haemoglobin – a component of red blood cells that pick up oxygen from the lungs and carries it round the body, dropping it off where it is needed in the tissues.
  2. Myoglobin – a protein in the muscles that stores and releases oxygen for use

So in a nutshell, the body needs iron to function. Full stop.

Kids of all ages are at risk of iron deficiency for various reasons, but mainly because they need increased amounts of iron in their diet to be able to grow.  If a child’s diet does not contain enough iron, they will eventually develop anaemia – which means that there is a lower than normal number of red blood cells (or haemoglobin IN the red blood cells), that results in the body cells being deprived of oxygen. As ALL of the body’s tissues need oxygen to work, the effects of iron deficiency anaemia are wide ranging and include:

  • Failure to thrive (or poor weight gain)
  • Decreased exercise tolerance (and breathlessness)
  • Feeling tired a lot (lethargy)
  • Poor attention and concentration at school and behavioural problems
  • Increased sweating
  • Frequent infections
  • Weird food cravings, like eating dirt or non-food items (this is called pica)
  • Poor appetite

RISK FACTORS

Certain kids are at higher risk of developing iron deficiency and these include:

  • Babies who are born prematurely (earlier than 37 weeks gestation) or have a low birth weight (less than 2.5 kg)
  • Exclusive breastfeeding past 6 months (without the introduction of solid foods)
  • Consumption of large volumes of cow’s milk in kids under 2 years old
  • Those who have a vegetarian or vegan diet
  • Low or no meat intake
  • Fussy eaters or those with poor diet in their 2nd year of life
  • Those with gastrointestinal diseases (eg Coeliac’s disease)

Having said all of this, it is REALLY important to note that **iron is toxic in large doses!**

So even if you suspect that your fussy eating/skinny/meat-hating flower-child is iron deficient, DO NOT self diagnose and just give them an iron supplement because an iron overdose can be FATAL!  To diagnose iron deficiency, a doctor needs to take a history, examine your child, order a blood test (or a few) and review the results.  When or IF the decision is made to put your child on an iron supplement, then the blood test will be repeated in 3-4 months to CHECK that the right dose has been given AND to make sure we haven’t “overshot” the mark.  The doctor will continue to monitor your child (ie even past taking them OFF the supplement) to make sure that their iron levels remain normal.

 

So I mentioned that there are different reasons for iron deficiency in kids of different ages.  These are some common causes of iron deficiency in various age groups and what we can do about it:

Babies less than 6 months old

These babies get their iron whilst they are still in-utero – from their mother’s blood.  This means that a woman’s diet during pregnancy is REALLY important.  Babies who are born prematurely (before 37 weeks gestation) or those who are really small (low birth weight) at birth are at higher risk of iron deficiency and usually needs supplements under the supervision of their GP or paediatrician.

  • What to do about it?
    • Eat lots of iron rich food (eg beef, lamb) during pregnancy
    • Let your doctor order a blood test to check for iron deficiency (and other things); take your supplement only as directed
    • Breastmilk does contain iron, just not that much. So either breastfeed or choose an iron-containing formula (pretty much all of them do) suitable for your baby’s age.  Don’t give cow’s milk before the age of 12 months as this discourages a good appetite for solids
    • Don’t delay introduction of solid food!! You can start introducing solids (smooth/pureed) at 4 months, but any time between 4-6 months is okay.

Babies 6 months – 12 months

The store of iron that babies have from their mother during pregnancy starts to run out in the 2nd half of a baby’s first year of life.  If the baby hasn’t had a good introduction of solid foods that contain iron at the right time, then they can run into trouble. I usually recommend introduction of solids at 4 months of age (I know, I know… I need to do a post on introduction of solid food too… I’ll get there eventually!!) – usually initially baby cereal (which is fortified with iron) or pureed veggies/fruit, later mixing in various pureed meats once the baby has got the hang of the early stuff.  If you introduce solids too late, then this can put your baby at risk of iron deficiency.

12 months – 5 years

In this age group, common causes of iron deficiency are

  • Too much milk: eg prolonged breastfeeding or excessive consumption of low-iron milks (eg cow/goat/soy milk)  where the milk replaces solid foods in the diet (ie the child drinks too much and is too full to eat solid food)
  • Poor intake of solids/fussy eaters
  • Chronic diarrhoea or parasitic infection

Often, it is a combination of both of these.

  • What to do about it?
    • Include lean, red meat (beef, lamb) in the diet 3-4 times a week. Other dietary sources of iron include: beans, lentils, chickpeas, chicken, fish, eggs and there is a small amount in nuts.  If your family is vegan or vegetarian then it might be advisable to see a paediatric dietician to make sure there is enough iron in your child’s food.
    • Vitamin C helps the body to absorb more iron! Foods like oranges, berries, tomatoes, broccoli and capsicum are all good sources and including these is beneficial
    • Offer solid food BEFORE drinks at mealtimes
    • If you have a fussy eater, see a paediatric dietician!

Teenagers

Girls especially in this age group are at risk of iron deficiency because they start to lose iron through menstruation (periods) and they are more likely than other children to restrict eating due to dieting.

  • What to do about it?
    • Serve meat, fish or chicken with dinner (this kind of dietary iron is absorbed and used by the body HEAPS more easily than an iron supplement)
    • Choose iron-fortified cereal and bread
    • Ensure your child understands the importance of iron and how to get it in their diet so they can make the right choices themselves.

If you suspect or are worried about iron deficiency or anaemia in your child, go and see your GP.  Asides from dietary reasons, there are other medical reasons that need to be ruled out in the diagnosis.

 

TREATMENT for iron deficiency can include:

  1. Increasing dietary intake of iron with iron-rich foods (the best way)
  2. Iron supplementation – talk to you pharmacist about what preparations are available and what is most suitable for your child given their age and the dose they are prescribed (eg Incremin, Ferro-liquid etc). Remember giving iron WITH vitamin C, increases absorption of the iron! A dose will be calculated by your doctor (or pharmacist) depending on the degree of iron deficiency and your child’s age and weight.
  3. Treatment for infection (eg parasitic infection that might cause chronic diarrhoea)

Take home messages:

  1. Diagnosing and treating iron deficiency is hugely important in supporting children’s normal development
  2. Children are at risk of iron deficiency because they have increased need for dietary iron due to the fact that they are GROWING; this risk is increased in children with vegetarian diets
  3. If you are worried about iron deficiency in your child, then go and see your GP to get properly assessed; do not self-diagnose or self-treat
  4. Breastfeed or give babies under 12 months of age infant formula – NOT cow’s/goat’s/soy milk
  5. Give your child a supplement at the prescribed dose as directed by your doctor.  Keep iron supplements away from children – overdose can be FATAL
  6. Introduce solids to infants at 4-6 months of age
  7. If you need help with your child’s diet and intake – see an accredited paediatric dietician!

 

Until next time!

xxDr Megs

For more articles from Dr Megan Yap visit her blog – “Dr Megs – Paeds & Feeds” at http://www.kids-health.guru/

Have you used our service? We are always looking for ways to improve so please take the time to complete our survey.

 

What does a developmental ...
Have you ever wondered why your child does things that just don’t seem right or exhibits behaviour that you haven’t observed in other ...
What's the difference between a ...
General paediatricians can treat (or are involved in the care of) most medical and developmental problems in children; it's a skillset in itself ...
Easter holiday programs
Easter holiday programs. Holiday workshops are a great way to break up seemingly endless days at home, while at the same time providing a fantastic ...
Tummy Pain in children
Nothing worse for a parent than knowing your child is in pain or ill and not knowing what to do about it or whether to worry.  Tummy pain is a very ...
HEAD LICE (AND NITS)
So was contemplating what health topic I might blog about today and was scrolling back through past posts. My thought process was, “Ooooh!! I ...
Autistic Spectrum Disorder – ...
Hi there everyone, Here is the long anticipated “Part 2” to our enthralling article on Autistic Spectrum Disorders. Had an absolutely epic ...
Autistic Spectrum Disorder – ...
So it’s a big couple of weeks for parents and kids hasn’t it?  School has gone back for the year and things are returning to normal after what ...
Sleep problems
Sooooooo on the topic of “restfulness” – many of my patient’s parents and friends struggle with their children’s sleep (or lack thereof) and ...
Iron deficiency
Well hello again everyone! So today I thought I’d let you guys know about iron deficiency in children.  Quite a few bloggees recently ...
Mummy (parental) guilt
Hello again all you awesome peeps out there that look after little people. Today I am going to blog about “Mummy guilt.” If you are a dad, or ...
Screen time and electronic device ...
Helloooooooo there parents and carers! Electronic screens and “smart” devices.  Smart phones/iPhones, iPads, tablet android computers… These ...
Does my child need to see a ...
The first five years of your child’s life are critical for brain development. Early stimulation from all senses create the foundations for learning ...
Failure to thrive
The term “Failure to Thrive” is enough to strike fear in a parent or carer’s heart… Or at least it does in mine (but then, I’m an Asian mum ...
Itchy girls bits (vulvovaginitis)
So a really good mate of mine (who I haven’t caught up with for aaages – sorry Vick!!) texted me and suggested that I blog about thrush in little ...
National Disability Insurance ...
As many of you may be aware, the NDIS has started its roll out throughout Queensland. In fact there are over 7,000 people enrolled in Queensland ...
Constipation (part two)
Hi again mums and dads! So to continue on from where we left off last week on this “hard” topic (ha ha!), we were going to discuss the ...
Constipation (part one)
So I promised I would try to blog about constipation today.  I like to try to keep these blog posts relatively SHORT, so they are easy enough to ...
Sore throats
Sore throats are pretty common.  You know that ache of the start of a sore throat when it begins and you groan as you realise what is coming right?  ...
Being sun smart with kids
It is no news to Queenslanders that Australia is the “skin cancer capital of the world” – something we have all heard more than once.  But did ...
Excessive screen use and our kids
With advancing technology, our children seem to be spending more and more time using screens. The American academy of Paediatrics recommends NO ...