Overview

Anemia is a common health problem in children. The most common cause of anemia is not getting enough iron. A child who is anemic does not have enough red blood cells or enough hemoglobin. Hemoglobin is a protein that lets red blood cells carry oxygen to other cells in the body. Iron is needed to form hemoglobin.

Causes

Iron-deficiency anemia can be caused by:

  • Diets low in iron. A child gets iron from the food in his or her diet. But, only a small amount of the iron in food is actually absorbed by the body.
    • Full-term newborns, born to healthy mothers, have iron that they get during the last 3 months of pregnancy.
    • Infants of mothers with anemia or other health problems may not have enough iron stored. And infants born early may not get enough iron.
    • At 4 to 6 months of age, the iron stored during pregnancy is at a low level. And more iron is used as the infant grows.
    • The American Academy of Pediatrics (AAP) recommends feeding your infant only breastmilk for the first 6 months. But breastmilk does not have a lot of iron, so infants that are breastfed only, may not have enough iron.
    • Older infants and toddlers may not get enough iron from their diets.
  • Body changes. When the body goes through a growth spurt, it needs more iron for making more red blood cells.
  • Gastrointestinal tract problems. Poor absorption of iron is common after some forms of gastrointestinal surgeries. When you eat foods containing iron, most of the iron is absorbed in the upper small intestine. Any abnormalities in the gastrointestinal (GI) tract could alter iron absorption and cause iron-deficiency anemia.
  • Blood loss. Loss of blood can cause a decrease of iron. Sources of blood loss may include gastrointestinal bleeding, menstrual bleeding, or injury.

Symptoms

These are the most common symptoms of iron-deficiency anemia:

  • Pale skin
  • Irritability or fussiness
  • Lack of energy or tiring easily (fatigue)
  • Fast heart beat
  • Sore or swollen tongue
  • Enlarged spleen
  • Wanting to eat odd substances, such as dirt or ice (also called pica)

Diagnosis

In most cases, anemia is diagnosed with simple blood tests. Routine anemia screening is done because anemia is common in children and they often have no symptoms.

  • The AAP recommends anemia screening with a hemoglobin blood test for all infants at 12 months of age. The screening should also include a risk assessment. This is a group of questions to find risk factors for iron-deficiency anemia. Risk factors include feeding problems, poor growth, and special healthcare needs.
  • If the hemoglobin level is low, more blood tests are done.
  • If a risk factor is present at any age, blood tests are done. 
  • Blood tests for anemia may also be done during routine physical exam or checkups in children of any age.

Most anemia in children is diagnosed with these blood tests:

  • Hemoglobin and hematocrit. This is often the first screening test for anemia in children. It measures the amount of hemoglobin and red blood cells in the blood.
  • Complete blood count, or CBC. A complete blood count checks the red and white blood cells, blood clotting cells (platelets), and sometimes, young red blood cells (reticulocytes). It includes hemoglobin and hematocrit and more details about the red blood cells.
  • Peripheral smear. A small sample of blood is examined under a microscope. Blood cells are checked to see if they look normal or not.
  • Iron studies. Blood tests can be done to measure the amount of iron in your child's body.

Treatment

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

The AAP recommends the following to prevent iron-deficiency anemia: 

  • Beginning at 4 months of age, infants that are only breastfed or partially breastfed should be given a daily iron supplement until they begin eating iron-rich foods.
  • Infants that are formula-fed do not need iron supplements. The formula has iron added to it. Whole milk should not be given to infants less than 12 months old.
  • Infants and toddlers from 1 to 3 years old should have foods rich in iron. They include cereal that has iron added, red meats, and vegetables with iron. Fruits with vitamin C are also important. The vitamin C helps the body absorb the iron.

Treating iron-deficiency anemia includes:

  • Iron supplements. Iron drops or pills are taken over several months to increase iron levels in the blood. Iron supplements can irritate the stomach and discolor bowel movements. They should be taken on an empty stomach or with orange juice to increase absorption. They are much more effective than dietary changes alone. If the child can’t take drops or pills, IV iron may be needed, but this is very unusual.
  • Iron-rich diet. Eating a diet with iron-rich foods can help treat iron-deficiency anemia. Good sources of iron include:
    • Iron-enriched cereals, breads, pasta, and rice
    • Meats, such as beef, pork, lamb, liver, and other organ meats
    • Poultry, such as chicken, duck, turkey, (especially dark meat), and liver
    • Fish, such as shellfish, including clams, mussels, and oysters, sardines, and anchovies
    • Leafy greens of the cabbage family, such as broccoli, kale, turnip greens, and collards
    • Legumes, such as lima beans and green peas; dry beans and peas, such as pinto beans, black-eyed peas, and canned baked beans
    • Yeast-leavened whole-wheat bread and rolls

Complications

Iron-deficiency anemia may cause delayed growth and development.

Prevention

You can often prevent iron-deficiency anemia through screening and taking iron supplements.

When to Call a Healthcare Provider

Call your child's healthcare provider if your infant is not nursing well. Or if your toddler or child has any of the signs of iron-deficiency anemia.

Key Points

  • Iron-deficiency anemia is not having enough iron in the blood. Iron is needed for hemoglobin.
  • Breastfed only infants should be given iron beginning at 4 months of age.
  • When infants are 12 months old, they should be screened for iron-deficiency anemia.
  • Iron supplement and iron-rich foods are used to treat iron-deficiency anemia.

Next Steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.