Iron Deficiency Anemia

Dear Lisa,

My 2 year old son went to the Pediatrician’s for a check up yesterday and the doctor told me that his hemoglobin level was lower than normal and he has mild anemia. The doctor said that my son was not getting enough iron in his diet and told me that I have to start giving him more food with iron. I admit, he is a very picky eater, but I thought that I was giving him nutritious food. Are there any other reasons besides improper diet that cause inadequate amounts of iron? What foods are a good source of iron? Any foods that kids like?

“Need more Iron in Son’s Diet”

Dear “Need more Iron in Son’s Diet”,

Iron Deficiency Anemia is the most common cause of childhood anemia. The major factors that cause Iron Deficiency Anemia in children include the rapid increase in body size (blood volume) of a child and the insufficient amount of iron in the child’s diet. Young Children, two years old and younger and teenagers are at the greatest risk for developing Iron Deficiency Anemia. Children 2 years old and younger are particularly at risk for developing Iron Deficiency Anemia because of their high rate of body growth during this period of their life combined with poor dietary iron intake. (1)

Children who drink a lot of cow’s milk (more than 1 quart per day) also tend to develop Iron Deficiency Anemia. (3) It is thought that microscopic amounts of blood are lost in the stool in children who drink a lot of milk. (2,3) In addition the phosphate found in cow’s milk binds with iron removing it from the body. This prevents the body from absorbing the amount of iron that is needed. (3) If you son drinks more than 24 ounces of milk per day and is a picky eater, he may be filling up on milk and need more iron fortified solids in his diet.(3)

Some children develop Iron Deficiency Anemia because they have “Pica”. (1) Pica is a condition where children purposefully ingest objects with no nutritional value. Children with Pica tend to put everything in their mouth and eat it. These children can commonly be found eating things such as paper, clay, plaster, dirt, hair or paint chips. (3)

Foods that are high in iron include liver, iron fortified cereals, iron fortified pastas, iron fortified breads, dried fruit, beans, meat, and eggs. (3,4) Liver contains the most iron, but it may be impossible to get a child to eat it. However, many children will eat a slice of liverwurst. I recommend a low fat brand of liverwurst because it is less sticky and easier for a child to pick up. Regular liverwurst is very sticky and many children do not like the texture and consistency on their fingers.

Luckily, most children do like Cheerios which is a good source of iron. One half cup of cheerios with skim milk fulfills 50% or half of all the iron requirements needed for a child under 4 years old. One whole egg contains approximately 1.2 mg of iron. Therefore mixing an egg into soups, pasta, rice or as an additive to recipes will increase the amount of iron that your child ingests per day. A small hamburger patty contains approximately 1.5 mg of iron, and many children like to eat hamburgers on a roll.

Four halves of dried apricots contains 1.7 mg of iron, which is also a great source of iron. Spinach, another good source of iron contains 1 mg of iron per 1/4 cup. Unfortunately, most children do not like spinach but they are likely to eat it if you mix it in their food. You can add pureed spinach or spinach from a jar of baby food to soups, pastina or red sauce in order to get your child to eat it. Adding Molasses to recipes also adds iron to a child's diet. Molasses contains 1.2 mg of iron per Tablespoon. You can add one tablespoon of Molasses to muffin mix, bread mix or cake mix when baking. This will not only increase your child’s iron intake but add moisture to the recipe. Children who refuse to eat beans may eat nachos with a bean dip.

Not all of the iron available in a food source is absorbed by the body. (3) The bioavailability of iron from food sources ranges from only 1 to 20 percent. In other words, if your child consumes a food source containing 10mg of iron only 1 mg or ten percent of the iron is actually absorbed from the intestine. Foods enriched with Vitamin C improve the absorption of iron; therefore it is a good idea to give children fruits and juices containing vitamin C with meals. (3)

The symptoms of Iron Deficiency Anemia are often vague and non-specific. Children may have pallor (be pale in color), irritability, anorexia (lack of appetite) and growth retardation. (3) Sometimes children do not have any symptoms at all. Iron deficiency anemia can become severe with long term consequences affecting a child’s heart, kidney and neurological system if not addressed. Therefore it is very important to follow up with your child’s Pediatrician so that he can monitor your son’s progress. Since there may be no signs that a parent can identify that indicate worsening of the condition, repeat blood tests for hemoglobin levels are necessary. If a child’s hemoglobin level does not improve after dietary changes your Doctor may prescribe an iron supplement or vitamins with iron and order additional testing.

References:
(1) Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc 1990:440-442.
(2)Graham M, Uphold C. Clinical Guidelines in Child Health. Gainsville, Florida: Barmarrae Books. 1994:617-620.
(3) Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:1406-1409.
(4) Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984: 124 -132.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

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