Iron deficiency in infants and children

We provide tips for dealing with this surprisingly common condition.

26 November 2013
by Monica Boshoff

"Iron is an essential mineral required by the body for normal growth and metabolism," says Cape Town paediatrician Dr Iqbal Karbanee. "Even though very small amounts are necessary, to get enough iron from the diet can be a problem. This is compounded when the body requires more iron than usual. If a child has a normal balanced diet, then the amount of supplementation necessary not only for iron but other minerals is very little, but in the picky or fussy eater, or in the baby who is on a predominantly milk diet, there may not be enough iron taken into the body," he says.

Insufficient iron in the body can lead to iron-deficiency anaemia. The blood requires iron for normal functioning, and when there is inadequate iron in the body, the blood becomes thinner and less efficient at carrying oxygen. This results in poor growth, tiredness and fatigue, and when severe can even affect the heart. Infancy is a particularly vulnerable period, and a time of high risk for iron-deficiency anaemia, says Dr Karbanee.

Iron deficiency in infants

All babies between the age of nine and 24 months are susceptible to an iron deficiency as this is a period of rapid growth, however certain infants are at an increased risk, as follows:

  • Premature birth (born earlier than three weeks before birth date)
  • Babies who have a low birth weight, less than 2500g
  • Babies who aren’t breastfed or given iron fortified milk alternatives
  • The introduction of cow’s milk before 12 months of age
  • High intake of cow’s milk, which actually inhibits the body from absorbing iron from other food
  • Babies who aren’t given solids after six months of age, when the milk doesn’t supply sufficient iron

Recognising the signs of iron deficiency can be tricky. "The symptoms can be very subtle and develop slowly," says Dr Karbanee. "In infants, the main symptoms include falling off their growth curve in weight and height, tiredness and irritability, and a general feeling of being weak and unwell. Many conditions can mimic these symptoms and thus it is not easy to pick up." If in doubt, consult with your paediatrician for advice.

How to treat it

The treatment of iron-deficiency anaemia is very simple and relatively inexpensive by means of iron supplementation. Some authorities advocate iron supplementation for all infants, and this is particularly recommended for all breastfed infants after the age of three months, says Dr Karbanee.

Between five and six months old, depending on your baby’s growth and recommendation from the doctor, you need to start introducing food in the form of puréed vegetables, fruits, and iron-rich cereals, he advises, as the baby’s dietary needs are not solely met by milk at this stage.

Consider cooking red meat until tender and putting it in a blender so the consistency is smooth, and add to your baby’s diet from about seven to eight months of age. Once your baby is well established on solids, try to include a variety of iron-rich foods in their diet.

The following foods are a good source of iron:

  • Oatmeal
  • Prunes
  • Raisins
  • Spinach and other greens
  • Tuna
  • Meat (red or white)
  • Dried beans and lentils
  • Eggs
  • Fish
  • Peanut butter
  • Soybeans

Note that not all of these foods are suitable for infants. Dried food should not be introduced before one year of age, as they present a choking hazard. Egg whites are also not advised in the first year, as they can induce an allergic reaction in susceptible babies. 

Older children will benefit from a vitamin supplement high in vitamin C, which helps the body absorb iron from food much more effectively. All in all, well-balanced meals with as much unprocessed foods as possible and a variety of vegetables, wholegrain cereals and protein, should set your child on a healthy path for life, with sufficient nutrients to meet their growing needs.
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