Iron deficiency and anemia in kids: what to know

Everyone needs iron to keep their bodies strong. It’s an important part of hemoglobin, the part of the red blood cells that carry oxygen from the lungs to the rest of the body. A child who isn’t getting enough iron can have learning or behavioral problems since it’s an important source of energy, muscle function and brain development.

How much iron does a child need?

The amount of iron that a child needs depends on their age. This chart provides accurate information for you to follow:

In developed countries, such as the United States, healthy babies typically get enough iron in their diet through breast milk or formula that’s fortified with iron. When they begin to eat other complementary foods, though, they may begin to not get enough iron depending on the foods they’re consuming. And cow’s milk actually makes it harder for the body to absorb iron. 

Toddlers can develop iron deficiency anemia if they drink too much cow’s milk, such as more than 24 ounces a day. Toddlers also at this age need to eat enough foods that are rich in iron, such as green leafy vegetables and red meat. Older kids who are picky eaters may also not be getting enough iron in their daily diet either, especially for those who are on a vegetarian diet.

Iron deficiency anemia is more common in teenage girls than teenage boys, because their bodies can’t store as much iron in addition to the loss of blood they experience during menstrual cycle each month. For teenage boys, the rapid growth associated with puberty may also lead to iron deficiency.

Symptoms of anemia in children

Over time, a child who’s iron deficient will have symptoms of anemia if the deficiency isn’t corrected.  If a child isn’t getting enough iron, the amount of iron in their body will decrease. This will first affect their muscle and brain function, since the body is using all the available iron to make their hemoglobin. 

When their level of iron continues to go down, their body will then make fewer red blood cells, which ultimately leads to anemia.

Some common symptoms associated with iron deficiency anemia include:

• Feelings of weakness and tiredness
• Pale skin, especially around the hands, nails and eyelids
• Fast heartbeat or a heart murmur
• Fast breathing
• Irritability
• Poor appetite
• Lightheadedness or dizziness

In rare cases when iron deficiency is severe, a child may develop pica, where a child will crave items that aren’t food, such as dirt, paint chips, chalk and/or ice.

How is iron deficiency anemia diagnosed?

The American Academy of Pediatrics recommends that all babies have a blood test done within the first year of life that screens for anemia. This usually happens around age one. Some babies will have this done earlier than others, depending on risk factors for anemia, such as babies who are premature or babies who were considered very low birthweight. In older children, a doctor may check a blood test depending on the symptoms that they’re having. 

They may also check a stool sample to make sure the child isn’t losing blood through their gastrointestinal tract. Common blood tests used to check for iron deficiency anemia are hemoglobin, hematocrit and/or iron levels.

How is iron deficiency anemia diagnosed?

Once a child is found to have iron deficiency anemia, they’ll typically require a daily iron supplement by mouth to increase their iron levels and hemoglobin back to its normal range.

• Multivitamins that contain iron and dietary changes may help. However, this is typically not enough once the patient is anemic.
• It's important that iron supplements are taken on an empty stomach, or with a small amount of food, so they can be absorbed properly. Children should not take iron with milk or caffeinated drinks.
• It's helpful for kids to take iron with foods that are high in vitamin C, such as orange juice, strawberries, bell peppers, and tomatoes. These foods will help to absorb the iron.
• Kids should start to feel better within a few days after starting iron supplementation. The hemoglobin levels will start to go up after about one month as more red blood cells are made.
• Kids usually need to take iron supplements for three to six months, but sometimes need to be treated for longer.

If there's no response to initial treatment, your child might be getting the wrong dose of iron or their body isn’t absorbing the iron correctly. In these cases, your doctor will want to check a repeat blood and iron levels, and your child may need to see a pediatric hematologist who specializes in blood disorders.

Preventing iron deficiency anemia 

Infants younger than one should only drink breast milk or formula that contains iron. Once they begin to eat solid foods around six months old, their food should be iron fortified. Toddlers under the age of two should only have 24 ounces of whole milk a day.

All children should have foods that are good sources of iron, such as red meat, chicken, fish, green leafy vegetables and beans (the table below that shows the amount of iron in a wide variety of food.)

Check out other recommendations from healthychildren.org to find ways to increase the amount of iron in your teenager’s diet. Iron from most animal sources (heme iron) usually is more readily absorbed than iron from plant sources of food (non-heme iron). 

Sources of Predominantly Heme Iron include: