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Iron-Deficiency Anemia

Ensuring your children get all the nutrients they need can be difficult. Even if you think you prepare balanced meals - and you keep a copy of the Food Guide Pyramid taped to the refrigerator - your kids may be missing out on a key nutrient: iron.

Iron is a necessary mineral for body function and good health. Every red blood cell in the body contains iron in its hemoglobin, the pigment that carries oxygen to the tissues from the lungs. But a lack of iron in the blood can lead to iron-deficiency anemia, the most common nutritional deficiency in the world. Keep reading to find out more about this disorder and how it can be treated.

What Is Iron-Deficiency Anemia?
When a person doesn't have enough iron, it can lead to a condition known as iron-deficiency anemia. Although iron deficiency has long been considered the major cause of anemia in childhood, it's become much less common in the United States over the past 30 years, primarily due to iron-fortified infant formulas and cereals.

The body needs iron to make hemoglobin. If not enough iron is available, hemoglobin production is limited, which in turns affects the production of red blood cells. A decrease in the normal amount of hemoglobin and red blood cells circulating in the bloodstream is known as anemia. Because red blood cells are needed to carry oxygen throughout the body, anemia results in less oxygen reaching the cells and tissues, affecting their function.

Iron-deficiency anemia doesn't develop immediately. Instead, a person progresses through stages of iron deficiency, beginning with iron depletion, in which the amount of iron in the body is reduced but the amount of iron in the red blood cells remains constant. If iron depletion isn't corrected, it progresses to iron deficiency, eventually leading to iron-deficiency anemia.

What Causes It?
Iron-deficiency anemia can be the consequence of several factors, including:

• insufficient iron in the diet
• poor absorption of iron by the body
• ongoing blood loss, most commonly from menstruation or from gradual blood loss in the intestinal tract
• periods of rapid growth

A diet low in iron is most often behind iron-deficiency anemia in infants, toddlers, and teens. Children who don't eat enough or who eat foods that are poor sources of iron are at risk for developing iron-deficiency anemia. Poverty is a contributing factor to iron-deficiency anemia because families living at or below the poverty level may not be getting enough iron-rich foods.

Iron deficiency can also lead to better absorption of lead, which increases the risk of lead poisoning in children, especially those living in older homes. The combination of iron-deficiency anemia and lead poisoning can make children very ill and can put them at risk for learning and behavioral problems.

During infancy and adolescence, the body demands more iron. Children are at higher risk for iron-deficiency anemia through these periods of rapid growth because they may not be getting enough iron in their diet to make up for the increased needs.

In infants, discontinuing iron-fortified formula and introducing cow's milk before 12 months can lead to iron-deficiency anemia. Cow's milk is low in the iron necessary for infant growth and development and it often replaces the consumption of iron-rich foods. Milk decreases the absorption of iron and can also irritate the lining of the intestine, causing small amounts of bleeding. This slow, gradual loss of blood in the stool - combined with low iron intake - may eventually result in iron deficiency and anemia.

Prematurity and low birth weight are other factors that put an infant at risk for iron-deficiency anemia. Before birth, full-term, normal-weight babies have developed iron stores that can last them 4 to 6 months. Because preemies don't spend as much time in the uterus getting nutrients from the mother's diet, their iron stores are not as great and are often depleted in just 2 months.

Children between the ages of 1 and 3 years are at risk of iron deficiency and iron-deficiency anemia, even though it isn't a period of exceptional growth. Most toddlers are no longer consuming iron-fortified formula and infant cereal, and they aren't eating enough iron-rich foods to make up the difference. Toddlers also tend to drink a lot of cow's milk, often more than 24 ounces a day.

During the first stages of puberty, when a lot of growth occurs, boys are at risk of iron-deficiency anemia. Adolescent girls are at higher risk because of menstrual blood loss and smaller iron stores as compared with boys. Many girls also tend to consume a diet low in iron.

What Are the Signs and Symptoms?
Many people with iron deficiency don't have any signs and symptoms because the body's iron stores are depleted slowly. As the anemia progresses, you may recognize some of the following symptoms in your child:

• fatigue and weakness
• pale skin and mucous membranes
• rapid heartbeat or a new heart murmur (detected in an exam by your child's doctor) irritability
• decreased appetite
• dizziness or a feeling of being lightheaded,

Rarely, a person with iron-deficiency anemia may experience pica, a craving to eat nonfood items such as paint chips, chalk, or dirt. Pica may be caused by a lack of iron in the diet.

How Is It Diagnosed?
Iron-deficiency anemia is often picked up during a routine exam. Because symptoms of iron-deficiency anemia, such as fatigue and decreased appetite, are common to many conditions, your child's doctor will need more information to make a diagnosis. A doctor who suspects iron-deficiency anemia will probably ask questions about your child's diet.

In addition, your child may need a blood test, which may include some or all of the following indicators of iron deficiency:

• A complete blood count (CBC) may reveal low hemoglobin levels and low hematocrit (the percentage of the blood made up of red blood cells). The CBC also gives information about the size of the red blood cells (RBCs). RBCs with low hemoglobin tend to be smaller and less pigmented.
• The reticulocyte count measures the number of immature red blood cells being produced. This is a useful test because it can indicate a problem before anemia develops.
• Serum iron directly measures the amount of iron in the blood, but may not accurately reflect how much iron is concentrated in the body's cells.
• Serum ferritin reflects total body iron stores. It's one of the earliest indicators of depleted iron levels, especially when used in conjunction with other tests, such as a CBC.

The doctor may also check your child's stool for blood because iron-deficiency anemia can be caused by gradual loss of small amounts of blood through the gastrointestinal tract. Since the blood may not be visible, a stool sample is placed on a special paper card and a drop of testing solution is applied. A color change indicates the presence of blood.

How Is It Treated?

Even though most cases of iron-deficiency anemia are the result of poor dietary iron intake, diet changes alone usually aren't enough to replenish depleted iron stores. Likewise, multivitamins with iron aren't adequate for children with iron-deficiency anemia who have such low iron stores, so a separate daily iron supplement may be required.

It's extremely important to remember that your child should not be given potent iron supplements without first consulting a doctor. Taking too much iron is a major cause of serious poisoning in children, according to the American Academy of Pediatrics.

Iron is best absorbed on an empty stomach, but can occasionally cause stomach upset. Children who experience stomach problems when taking iron supplements may need to take them with a small amount of food. Iron should not, however, be given with milk or caffeinated beverages, which will interfere with absorption. Vitamin C enhances iron absorption, so it's a good idea to include plenty of sources of vitamin C in your child's diet.

After the first month on iron supplements, your child's doctor may want to repeat the blood tests to check that hemoglobin and hematocrit levels are improving. If there's a good response, the doctor will probably continue the iron supplement for several more months. Once corrected, iron stores can be maintained with an iron-rich diet. About 6 months after discontinuing iron therapy, the doctor may want to recheck your child's hemoglobin.

Rarely, iron-deficiency anemia is so severe that hospitalization may be necessary. A blood transfusion may be required to treat severe, life-threatening anemia.

Caring for Your Child

The effects of iron-deficiency anemia will depend on the duration and severity of the anemia. If left untreated, iron-deficiency anemia may lead to behavioral or learning problems. These may not be reversible, even with later iron supplementation.

But in most cases, iron-deficiency anemia is preventable by following some basic recommendations:

• Infants younger than 1 year should drink only breast milk or an infant formula supplemented with iron. The breastfed infant should be given iron supplements.
• Children under 2 years should have no more than 24 ounces of cow's milk a day. As noted earlier, milk can inhibit absorption of iron, and drinking too much milk can dampen a child's appetite for other iron-rich foods. In addition, too much cow's milk has been shown to irritate the gastrointestinal tract, which may cause intestinal bleeding - a cause of iron loss.
• Iron-fortified products such as cereal can be a great way to get children - especially those under the age of 2 years - to get more iron.
• A variety of foods can provide your family with nutritious sources of iron: lean meats, eggs, green leafy vegetables, dried peas and beans, blackstrap molasses, raisins, and whole-grain bread.
• Make sure children or teens on a vegetarian diet are getting enough iron. Because iron from meat sources is more easily absorbed than iron from plant sources, you may need to add iron-fortified foods to their diet.

Proper nutrition, which includes a diet rich in iron, is important for all children. Establishing good eating habits early in life will help to prevent iron deficiency and iron-deficiency anemia.