Iron Deficiency Anemia, Pediatric

Iron deficiency anemia is a condition in which the concentration of red blood cells or hemoglobin in the blood is below normal because of too little iron. Hemoglobin is a substance in red blood cells that carries oxygen to the body's tissues. When the concentration of red blood cells or hemoglobin is too low, not enough oxygen reaches these tissues. Iron deficiency anemia is usually long-lasting (chronic) and develops over time. It may or may not be associated with symptoms.

Iron deficiency anemia is a common type of anemia. It is often seen in infancy and childhood because the body demands more iron during these stages of rapid growth. If left untreated, it can affect growth, behavior, and school performance.

CAUSES

  • Not enough iron in the diet. This is the most common cause of iron deficiency anemia.  

  • Maternal iron deficiency.  

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

  • Blood loss from a gastrointestinal condition like Crohn disease or switching to cow's milk before 1 year of age.  

  • Frequent blood draws.  

  • Abnormal absorption in the gut.

RISK FACTORS

  • Being born prematurely.  

  • Drinking whole milk before 1 year of age.  

  • Drinking formula that is not iron fortified.

  • Maternal iron deficiency.  

SIGNS & SYMPTOMS

Symptoms are usually not present. If they do occur they may include:

  • Delayed cognitive and psychomotor development. This means the child's thinking and movement skills do not develop as they should.  

  • Feeling tired and weak.  

  • Pale skin, lips, and nail beds.  

  • Poor appetite.  

  • Cold hands or feet.  

  • Headaches.  

  • Feeling dizzy or lightheaded.  

  • Rapid heartbeat.  

  • Attention deficit hyperactivity disorder (ADHD) in adolescents.  

  • Irritability. This is more common in severe anemia.

  • Breathing fast. This is more common in severe anemia.

DIAGNOSIS

Your child's health care provider will screen for iron deficiency anemia if your child has certain risk factors. If your child does not have risk factors, iron deficiency anemia may be discovered after a routine physical exam. Tests to diagnose the condition include:

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

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

  • A test where marrow cells are removed from bone marrow (bone marrow aspiration) or fluid is removed from the bone marrow (biopsy). These tests are rarely needed.  

TREATMENT

Iron deficiency anemia can be treated effectively. Treatment may include the following:

  • Making nutritional changes.  

  • Adding iron-fortified formula or iron-rich foods to your child's diet.  

  • Removing cow's milk from your child's diet.  

  • Giving your child oral iron therapy.  

In rare cases, your child may need to receive iron through an IV tube.

Your child's health care provider will likely repeat blood tests after 4 weeks of treatment to determine if the treatment is working. If your child does not appear to be responding, additional testing may be necessary.

HOME CARE INSTRUCTIONS

  • Give your child vitamins as directed by your child's health care provider.  

  • Give your child supplements as directed by your child's health care provider. This is important because too much iron can be toxic to children. Iron supplements are best absorbed on an empty stomach.  

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

  • Include iron-rich foods in your child's diet as recommended by your health care provider. Examples include meat; liver; egg yolks; green, leafy vegetables; raisins; and iron-fortified cereals and breads. Make sure the foods are appropriate for your child's age.  

  • Switch from cow's milk to an alternative such as rice milk if directed by your child's health care provider.  

  • 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.  

  • Alert your child's school that your child has anemia. Until iron levels return to normal, your child may tire easily.  

  • Follow up with your child's health care provider for blood tests.  

PREVENTION

Without proper treatment, iron deficiency anemia can return. Talk to your health care provider about how to prevent this from happening. Usually, premature infants who are breast fed should receive a daily iron supplement from 1 month to 1 year of life. Babies that are not premature but are exclusively breast fed should receive an iron supplement beginning at 4 months. Supplementation should be continued until your child starts eating iron-containing foods. Babies fed formula containing iron should have their iron level checked at several months of age and may require an iron supplement. Babies that get more than half of their nutrition from the breast may also need an iron supplement.

SEEK MEDICAL CARE IF:

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

  • Your child has pale lips, eyelids, and nail beds.  

  • Your child is unusually irritable.  

  • Your child is unusually tired or weak.  

  • Your child is constipated.  

  • Your child has an unexpected loss of appetite.  

  • Your child has unusually cold hands and feet.  

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

  • Your child has an upset stomach.  

  • Your child will not take prescribed medicines.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Your child has severe dizziness or lightheadedness.  

  • Your child is fainting or passing out.  

  • Your child has a rapid heartbeat.  

  • Your child has 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: www.anemia.org/patients

American Academy of Pediatrics: www.aap.org

American Academy of Family Physicians: www.aafp.org