Iron Deficiency Anemia

At the one year visit, I screen at risk children for iron-deficiency anemia and lead poisoning.

Iron is an important component of red blood cells, the cells in the body that carry oxygen to the tissues.  When you don't have enough red blood cells, you have anemia (some people call it "low blood") and you can be tired and pale.  Screening for it allows us to intervene early before the fatigue and pallor settle in.  I can tell if your child has other types of anemia through the same blood test, but iron deficiency is by far the most common anemia in children.

consequence of anemia

Children who are anemic can have school problems, behavior problems, poor attention spans and developmental  delay along with pallor and fatigue. (And the deficits in development may not reverse when we start iron supplementation.)  Some children develop a condition called pica, where they eat weird stuff like dirt and stuffed animals. The iron deficiency can actually make it easier to absorb lead. If untreated, the anemia can lead to heart failure.

staying on formula

Now, iron deficiency is rare in kids under 6 months of age, because most formulas are iron fortified (and if they aren't, you shouldn't be using them!). Children should be on formula until they are 1 year of age.  Of course, if you are breastfeeding, you can do it for however long you and your child want.  There is no cow anywhere that makes better milk for your child than you do!

importance of cow's milk

Anemia gets to be a problem when kids switch over to  cow's milk. Now I am a life-long Wisconsin resident, but milk is NOT the perfect food. Cow's milk protein interferes with iron absorption.  It contains no iron.  It has enough calories where kids may not want to eat anything else, including foods that contain iron. Everything in moderation-- no more than 20 ounces a day of milk.  I've seen kids drink so much milk and get such severe anemia that they have needed blood transfusions!

vitamin supplementation

We recommend an over the counter product called Fer-in-sol, a dropper to be taken every day.  But decreased milk intake an improved diet are key.

dietary suggestions

  • Breastfed infants:  there may be less iron in breastmilk than in formula, but the iron contained in breastmilk is more available for the body to use.  The breastmilk should be complemented at 6 months of age when the iron available in the milk is not enough to support the child.  Iron fortified cereal is a good place to start.  If the child doesn't want it, liquid vitamins (like Fer-in-sol) can be used.

  • Formula fed infants:  stay on formula until a year on age and make sure there is iron in the formula.  Start iron-fortified cereal at 6 months of age.

  • Meats: after 6 months, and when the child can handle texture, meats have the most absorbable form of iron.

  • Other foods high in iron: liver, clams, oysters, spinach, baked potato (with skin), black-eyed peas, raisins, avocado (obviously, these foods may work better with older kids)