Anemia caused by low iron - infants and toddlers
Anemia - iron deficiency - infants and toddlers
Anemia is a problem in which the body does not have enough healthy red blood cells. Red blood cells bring oxygen to body tissues.
Iron helps make red blood cells, so a lack of iron in the body may lead to anemia. The medical name of this problem is iron deficiency anemia.
To be anemic means that there aren't enough red blood cells flowing throughout your body. Red blood cells carry oxygen throughout your body, so if you're anemic, everything from your brain, to your heart, to your muscles aren't getting enough oxygen to run properly. Iron is a key part of red blood cells. When your body doesn't have enough iron, it'll make fewer red blood cells or make cells that are just too small. If you lose enough iron, you'll wind up with iron deficiency anemia - the most common form of anemia. So, what causes iron deficiency anemia? There are basically three main ways you can become iron deficient. First, bleeding can cause you to lose more blood cells and iron than your body can replace. Bleeding due to ulcers, cancers, taking aspirin or other medicines can cause anemia. In women, this can happen because of heavy or frequent menstrual periods. The second way, your body isn't properly absorbing iron, perhaps, due to an intestinal disease. Some surgeries, like gastric bypass, can lead to anemia. You can also develop anemia if you take too many antacids that contain calcium. Lastly and much less common, is because of inadequate iron in your diet. We see this in strict vegetarians and older folks who simply just don't eat enough food. In many cases, mild iron deficiency anemia comes on so gradually that you may not even know you're anemic. Symptoms of mild anemia are subtle and include feeling grumpy, weak or tired more often than usual and getting headaches or perhaps having problems concentrating. But as the anemia gets worse, you may develop a blue color to the whites of your eyes, light-headedness when you go to stand up and you may look pale or experience shortness of breath. To find out if you've got iron-deficiency anemia. See your doctor; your doctor will start with a Complete Blood Count or CBC test. That'll tell you and your doctor your white, red blood cell and platelet counts. If you're anemic and have small red blood cells, that suggests iron deficiency anemia, so iron studies like serum iron, total iron binding capacity and ferritin level tests should be done. So, what steps can you take -- It's important that your diet include enough iron. Red meat, chicken, turkey. liver, and egg yolks are important sources of iron. Flour, bread, and some cereals are fortified with iron. Sometimes people with anemia take iron supplements to build up iron stores in their bodies. But the thing is - It's not enough just to take extra iron at your doctor's direction...Your doctor needs to find out WHY you've got iron deficiency anemia and treat that underlying cause.
Causes
Anemia caused by a low iron level is the most common form of anemia. The body gets iron through certain foods. It also reuses iron from old red blood cells.
A diet that does not have enough iron is the most common cause. During periods of rapid growth, even more iron is needed.
Babies are born with iron stored in their bodies. Because they grow rapidly, infants and toddlers need to absorb a lot of iron each day. Iron deficiency anemia most commonly affects babies 9 through 24 months old.
Breastfed babies need less iron because iron is absorbed better when it is in breast milk. Formula with iron added (iron fortified) also provides enough iron.
Infants younger than 12 months who drink cow's milk rather than breast milk or iron-fortified formula are more likely to have anemia. Cow's milk leads to anemia because it:
- Has less iron
- Causes small amounts of blood loss from the intestines
- Makes it harder for the body to absorb iron
Children older than 12 months who drink too much cow's milk may also have anemia if they do not eat enough other healthy foods that have iron.
Symptoms
Mild anemia may have no symptoms. As the iron level and blood counts become lower, your infant or toddler may:
- Act irritable
- Become short of breath
- Crave unusual foods (called pica)
- Eat less food
- Feel tired or weak all the time
- Have a sore tongue
- Have headaches or dizziness
With more severe anemia, your child may have:
- Blue-tinged or pale whites of eyes
- Brittle nails
- Pale skin color
Exams and Tests
The health care provider will perform a physical exam. All babies should have a blood test to check for anemia. Blood tests that measure iron level in the body include:
A measurement called iron saturation (serum iron/TIBC) often can show whether the child has enough iron in the body.
Treatment
Since children only absorb a small amount of the iron they eat, most children need to have 8 to 10 mg of iron per day.
DIET AND IRON
During the first year of life:
- Do not give your baby cow's milk until age 1 year. Babies under age 1 year have a difficult time digesting cow's milk. Use either breast milk or formula fortified with iron.
- After 6 months, your baby will start to need more iron in their diet. Start solid foods with iron-fortified baby cereal mixed with breast milk or formula.
- Iron-rich pureed meats, fruits, and vegetables can also be started.
After age 1 year, you may give your baby whole milk in place of breast milk or formula.
Eating healthy foods is the most important way to prevent and treat iron deficiency. Good sources of iron include:
- Apricots
- Chicken, turkey, fish, and other meats
- Dried beans, lentils, and soybeans
- Eggs
- Liver
- Molasses
- Oatmeal
- Peanut butter
- Prune juice
- Raisins and prunes
- Spinach, kale and other greens
IRON SUPPLEMENTS
If a healthy diet does not prevent or treat your child's low iron level and anemia, the provider will likely recommend iron supplements for your child. These are taken by mouth.
Do not give your child iron supplements or vitamins with iron without checking with your child's provider. The provider will prescribe the right kind of supplement for your child. If your child takes too much iron, it can cause poisoning.
Outlook (Prognosis)
With treatment, the outcome is likely to be good. In most cases, the blood counts will return to normal in 2 months. It is important that the provider find the cause of your child's iron deficiency.
Possible Complications
A low iron level can cause decreased attention span, reduced alertness and learning problems in children.
A low iron level can cause the body to absorb too much lead.
Prevention
Eating healthy foods is the most important way to prevent and treat iron deficiency.
References
Baker RD, Baker SS. Infant and toddler nutrition. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Disease. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 85.
Powers JM, Brandow AM. Pallor and anemia. In: Kliegman RM, Toth H, Bordini BJ, Basel D, eds. Nelson Pediatric Symptom-Based Diagnosis. 2nd ed. Philadelphia, PA: Elsevier; 2023:chap 49.
Rothman JA. Iron-deficiency anemia. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 504.
Version Info
Last reviewed on: 2/17/2024
Reviewed by: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
