Iron Deficiency Anemia, Pediatric

Iron is an important mineral in the body. It helps the body carry oxygen to cells and tissues. Iron-deficiency anemia occurs when there is not enough:

  • Iron in the blood to make hemoglobin (an important protein).

  • Red blood cells (RBC).

It is a common type of anemia. Patient education, fortified foods, and screening continue are ways to improve the rate of iron deficiency anemia.

CAUSES

By far the most common reasons for iron deficiency anemia are nutritional, but some medical conditions leading to blood loss or poor absorption of iron can also be responsible. Causes and risk factors include:

  • Being born prematurely.

  • Maternal iron deficiency.

  • Not enough iron in the diet.

  • Blood loss caused by bleeding in the intestine (often caused by an irritation in the stomach from cow's milk).

  • Blood loss from a gastrointestinal condition like Chron's disease, switching to cow's milk before 1 year of age, or frequent blood draws in a premature infant.

Iron deficiency anemia is often seen in infancy and childhood since the body demands more iron during these stages of rapid growth.

SYMPTOMS

Most commonly, children do not have symptoms and iron deficiency anemia is identified as part of screening or other lab tests done as part of the care for your child. If symptoms do occur they may include:

  • Delayed cognitive and pscyhomotor development. (The child's thinking and movement skills do not develop as they should.)

  • Feeling tired and weak.

  • Pale skin, lips, and nail beds.

  • Irritability.

  • Poor appetite.

  • Cold hands or feet.

  • Headaches.

  • Feeling dizzy or lightheaded.

  • Rapid heartbeat.

  • Heart murmur (detected by your child's doctor).

  • Attention deficit hyperactivity disorder (ADHD) in adolescents.

DIAGNOSIS

Your doctor will screen for iron deficiency anemia if your child has certain risk factors like prematurity, is drinking whole milk before 1 year of age, or is not taking an iron fortified formula. Tests may include:

  • Physical exam.

  • Blood count and other blood tests including those that show how much iron is in the blood.

  • Stool sample test to see if there is blood in your child's bowel movement.

  • In rare cases, it is recommended that bone marrow aspiration (marrow cells are removed from the bone marrow) or biopsy (fluid is removed from the bone marrow) be done. These are done under local anesthesia and often performed together.

Additionally, for children without risks, iron levels will be checked as part of well child care.

TREATMENT

Anemia can be treated effectively. Once the diagnosis of iron deficiency anemia is made, treatment for your child may include the following:

  • Nutrition.

  • Adding iron-fortified formula and/or iron-rich foods to help increase iron stores.

  • Removing cow's milk from the diet.

  • Vitamins.

  • A multivitamin with iron or separate daily iron supplement. However, too much iron can be toxic in children. This needs to be prescribed and monitored by your child's caregiver.

Your doctor will likely repeat blood tests after 4 weeks of treatment to determine if your treatment is working.

HOME CARE INSTRUCTIONS

Without proper treatment, anemia can return. It may take a few weeks or months for iron levels to return to normal. When caring for your child, follow your doctor's instructions as well as these guidelines:

  • Give your child vitamins as directed. Iron supplements are best absorbed on an empty stomach. Discuss with your child's caregiver if stomach upset occurs.

  • Iron supplements can cause constipation. Make sure your child is drinking plenty of water and eating fiber-rich foods.

  • Include iron-rich foods in your child's diet as recommended. Examples include meat and liver, egg yolks, green leafy vegetables, raisins, as well as iron-fortified cereals and breads.

  • Your child's caregiver may recommend switching from cow's milk to an alternative such as soy or rice milk.

  • Add Vitamin C to your child's diet. Vitamin C helps the body absorb iron.

  • Teach your child good hygiene practices. Anemia can make your child more prone to illness and infection.

  • Until iron levels return to normal, your child may tire easily. Alert your child's school of the symptoms.

  • Follow up with your child's caregiver for blood tests as recommended.

If your child required hospitalization, follow the specific aftercare instructions provided by your caregiver.

PREVENTION

Premature infants who are breast fed should receive a daily iron supplement from 1 month to 1 year of life. Babies fed formula containing iron will have their iron level checked at several months of age and will require a supplement if it is low. If your baby was not premature, but is exclusively breast fed then your baby should receive an iron supplement beginning at 4 months and continue until your baby starts getting a diet that has iron containing foods. If your baby gets more than half of their nutrition from the breast you should talk with your doctor to see if an iron supplement is appropriate.

PROGNOSIS

Treatment for your child is important and quite effective. If left untreated, iron-deficiency anemia can affect growth, behavior, and school performance.

SEEK MEDICAL CARE IF:

  • Your child has pale, yellow, or gray skin tone.

  • Your child has pale lips, eyelids, and nailbeds.

  • Your child is unusually irritable.

  • Your child is unusually tired or weak.

  • Your child has constipation.

  • Your child has an unexpected loss of appetite.

  • Your child has unusual cold hands and feet.

  • Your child has headaches that had not previously been a problem.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Your child has severe dizziness or light-headedness.

  • Your child is fainting or passing out.

  • Your child has a rapid heartbeat; chest pain.

  • Your child has shortness of breath.

MAKE SURE YOU

  • Understand these instructions.

  • Will watch your child's condition.

  • Will get help right away if your child is not doing well or gets worse.

FOR MORE INFORMATION

  • National Anemia Action Council http://www.anemia.org/patients/

  • American Academy of Pediatrics http://www.aap.org/

  • American Academy of Family Physicians http://www.aafp.org/