Iron Deficiency In Infants And Children: It's Not Just About Anemia

Iron deficiency is the most common nutritional deficiency in children. In the United States, up to 9% of toddlers between 1 and 3 years of age, and 11% of adolescent girls have iron deficiency. Prematurity, early introduction of unmodified cow’s milk, obesity and continued bottle feeding during the second and third year of life are recognized risks for iron deficiency in young children. Poor diet and heavy menses are risks for the adolescent female. Most families understand that persistent iron deficiency leads to the development of anemia. However, there are other potentially important consequences of iron deficiency that may not be understood by parents. Adequate iron stores are essential for optimum brain function. Research has shown that iron deficient infants are at increased risk for modest declines in psychomotor and mental development. In clinical trials, infants at high risk for iron deficiency, when fed iron-fortified formulas, had significantly fewer declines in measures of psychomotor skills, when compared to infants who were not on fortified formula. In other studies, older children and adolescents with iron deficiency were shown to be at risk for declines in standardized tests scores in math and for attention and concentration difficulties. In one small clinical trial, children with attention deficit hyperactivity disorder (ADHD) and iron deficiency had significant improvement in ADHD scores after 12 weeks of iron supplementation. Finally, iron deficiency may play a role in other diverse conditions, such as restless leg syndrome and breath-holding attacks in children. Iron deficiency also causes mild defects within the immune system. Other examples of less commonly known complications of iron deficiency include alterations in exercise capacity and performance, particularly in adolescent athletes, and increased risk for clot formation in the brain, leading to stroke. Taken together, these observations confirm that iron is an essential element for virtually all the organs systems of the body. Prevention is the best treatment for iron deficiency. Prevention can be accomplished with appropriate diet and occasionally with the addition of modest supplementation. The dietary requirements are simple and can be summarized as follows:
  • In term, exclusively breastfed infants, begin iron supplement drops at 4 months of age.
  • In premature or low birth weight breast fed infants, begin iron supplement drops at 1 month of age.
  • At 6 months of age, add iron fortified cereals to the diet.
  • Avoid unmodified (nonformula) cow’s milk until age 12 months.
  • Children older than 12 months, transition off bottle feedings and avoid consuming more than 20 oz of milk per day.
  • Adolescent females, particularly active with heavy menses, should consider iron supplementation daily.
  • Iron supplements are best absorbed on an empty stomach.
  • Diet sources rich in iron include: meat, fish, poultry, lentils, dried beans, grain products, vegetables and dried fruits.
Families should discuss with their physicians how to ensure that their child is getting adequate dietary sources of iron to allow for optimum development during their growing years.