Iron deficient anaemia is the number one nutritional deficiency on the planet but what about its prevalence in Australian children?1 Well the statistics are frightening 10-20% are considered to have a low intake whilst anywhere between 3-48% are deficient.2,3
The Biggest Causes of a Deficiency
- Young children (toddlers) consuming large quantities of cow’s milk >600ml per day blocks the uptake of iron into the brain and other cells
- Prolonged breastfeeding with late introduction of solids
- Early introduction of cow’s milk (before age 1) instead of formula. Cow’s milk contains non-haem iron which is a poorly absorbable form of iron
- Pre-term infants are at risk, as iron stores are transferred from mother to baby in utero during the last trimester of pregnancy, meaning pre-terms infants miss out on this crucial nutrient.
- Fussy eaters who have a restricted or limited diet with little iron rich foods
- Parasites, recurrent gastroenteritis, coeliac disease and other gut inflammatory disorders
- High wheat diets commonly seen in children consuming lots of cereals, breads, pastas etc. Phytic acids in wheat block the absorption of iron
- Children on medication for reflux such as Losec, these medications reduce the absorption of iron into the body
What Does a Deficiency Look Like in a Small Child?
- Pale skin
- Purple colour under the eyes
- Tiredness, irritability, headaches, withdrawn behaviour
- Decreased school productivity
- Sleep issues
- Poor appetite
- Trouble keeping up with friends during physical activity (breathlessness)
- Frequent colds and flus
Iron is essential for the development of cognition, muscle strength, physical growth. A deficiency may result in:
- Delayed mental development
- Delayed psychomotor skills including coordination and fine motor skills like the pincer grasp that most children begin to develop around 7 months
What’s alarming is if an iron deficiency is severe during the ages of birth to 2 years of age and the deficiency is not reversed, delays in mental and psychomotor skills may not be reversible. This is because the blood brain barrier remains porous during the first 2 years of life to allow for movement of iron into the brain. After the age of 2 this barrier closes over reducing the amount of iron uptake into the brain.
Other Issues That Might Arise:
- Reduced resistance to infections with slow recovery times, this may present as the child not bouncing back quickly after a cold
- Poor cognitive function, think the child that is constantly whinging
- Fatigue and poor concentration
- Poor muscular strength
- Reduced physical growth
Tests to Assess Iron Status
Aside from assessing a child’s physical signs and symptoms a blood test can also be done to determine if a child has low iron. This is of course easier said than done. Obtaining a blood test sample from a toddler is rather difficult, this will be up to you and your healthcare provider as to which avenue you would like to take. Please note the values below that indicate low iron stores.
Haemoglobin can be assessed from a Full Blood Count (FBC) test
- Haemoglobin (Hb) <110g/L for children less than 5 years of age
- Haemoglobin (Hb) <115g/L for children 5-11 years of age
Iron tests are called Iron Studies on a blood test
- Low plasma ferritin <15-30ug/L indicates depleted stores of iron
- Iron Saturation should be at 35%
Enhancing Iron Absorption
- Delay offering cow’s milk until 12 months of age to prevent iron absorption being blocked by calcium
- Introduce meats, broths and other iron rich foods around 6-7 months of age
- Introduce foods containing vitamin C (fruit & veggies) with meals to enhance iron absorption
- Age Appropriate Foods to Include:
- 5-8 months: kiwi fruit, papaya, mango
- 9-12 months and older: orange, strawberries, dark leafy greens, broccoli, cauliflower + the fruits from the earlier age group
- Age Appropriate Foods to Include:
Brain development is rapid during the first few years of life making babies and toddlers vulnerable to vitamin and mineral deficiencies. Using the above foods and strategies mentioned above can go a long way to safeguarding your child against a possible iron deficiency.
- Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity; WHO, 2011
- Health DL, Panaretto KS. Nutrition status of primary school children in Townsville. Aust J Rural Health. 205 Oct ;13(5):282-9.
- Margaret Kerr et al. Iron status and anaemia in preschool children in Sydney. Australian and New Zealand Journal of Public Health. Volume 20, Issue 6, page 618-622, December 1996.