Iron Deficiency: A-to-Z Guide from Diagnosis to Treatment to Prevention

The most common reason for a child to be anemic is an inadequate supply of iron. It is often called iron deficiency anemia.

A baby is born with about 0.5 grams of iron in the body. A healthy adolescent’s body has 5.0 grams. This 900 percent increase in iron comes from the iron in the food your child eats or the vitamins she takes. Throughout childhood, a steady supply of iron enables your child to make healthy red blood cells, which will provide the oxygen needed for life, health, and growth.

What is iron deficiency?

The most common reason for a child to be anemic is an inadequate supply of iron. Iron is a mineral that your body needs in order to make red blood cells. Children who lack enough iron will make small, pale, ineffective red blood cells.

Who gets iron deficiency?

Children get iron deficiency anemia if they don’t eat enough iron-containing food, if they lose too much iron (through bleeding), or if their need for new red blood cells is increased (as in periods of rapid growth). Thus, iron deficiency anemia is most common in infants and in adolescents (especially adolescent girls).

Drinking too much milk can lead to iron deficiency. It irritates the intestines, and leads to iron loss. It can also make it more difficult for the body to use iron.

Most cases of severe iron deficiency in young children are in those who drink too much milk.

Food allergies can also lead to iron deficiency through iron loss in the stool.

Children with iron deficiency are more likely to have lead toxicity than their peers.

What are the symptoms?

In most children, the anemia never gets severe enough to cause noticeable symptoms, but it can still slow cognitive development. Iron deficiency (even mild enough not to cause anemia) is associated with a decrease in attention span, alertness, and learning ability. Iron-deficient children are also more likely to eat dirt, paint chips, ice, and other mineral-containing items.

Irritability and fatigue are common in mild to moderate iron deficiency anemia. The white part of the eyes can take on a bluish tint. The child may appear pale.

Prolonged or severe anemia can cause marked irritability, decreased appetite, slowed growth, a swollen tongue, and flattened, spoon-shaped, or brittle nails. There may be irritated sores at the corners of the mouth. In very severe cases, children can even go into heart failure.

Is iron deficiency contagious?


How long does it last?

Iron deficiency lasts until the body’s iron stores are replenished from the new iron taken in. With proper treatment, this usually takes one to three months.

Sometimes ongoing iron losses (as from too much milk) need to be corrected to solve the iron deficiency.

How is it diagnosed?

Most children get a blood test between 6 and 18 months of age to look for anemia. The blood test is important because it can identify anemia before there are any symptoms.

Anemia on the screening blood test is not necessarily caused by iron deficiency, but mild anemia in an otherwise well child is most likely caused by iron deficiency.

If the anemia does not respond as expected to treatment, other tests should be done to confirm that the problem is iron deficiency. Lead poisoning and thalassemia, for instance, can also produce anemia with small red blood cells.

How is it treated?

The dietary changes listed below (under prevention) are the foundation of treating iron deficiency. If there is significant anemia, or if the diet isn’t working, iron drops may be necessary to replenish your child’s iron stores.

When these drops are given with juice, they are often better tolerated and better absorbed. If they are given straight, they may darken the teeth. Iron drops can turn the stools dark and cause constipation, no matter how they are given.

The drops are usually given for about a month before a repeat blood test is performed to see if the anemia is resolving. If it is, the drops are given for another few months. If it is not, further investigation is needed into the many other possible causes of anemia.

How can iron deficiency be prevented?

Improving your child’s diet is the most important way to prevent and to treat iron deficiency. Many foods are good sources of iron:

  • Good — Tuna, oatmeal, apricots, raisins, spinach, kale, greens, prunes
  • Better — Eggs, meat, fish, chicken, turkey, soybeans, dried beans, peanut butter, peas, lentils, molasses
  • BestBreast milk (the iron is very easily used by the child), formula with iron, infant cereals, other iron-fortified cereals, liver, prune juice

The intestines of children who are being breast-fed are two to three times more efficient at absorbing iron from every source. Taking vitamin C, or eating foods high in vitamin C (such as orange juice) at the same time as foods high in iron, also helps the body absorb and use the iron. The iron in iron-fortified foods is poorly absorbed, but usually contains enough extra iron to compensate for this.

Cooking in iron pans can help by adding iron to the food. Taking an over-the-counter multi-vitaminwith iron can help provide a safety net for picky eaters.

Drinking too much cow’s milk makes anemia worse. Most toddlers get sufficient calories and calcium from 16-24 ounces of milk daily. No child needs more than 32 ounces of cow’s milk a day.

Last medical review on: February 01, 2010
About the Author
Photo of Alan Greene MD
Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
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