Iron Deficiency in Children. Dr. Narmin Azizova

Iron deficiency is one of the most common nutritional deficiencies worldwide, affecting all age groups. However, it is particularly prevalent in children aged 6 to 24 months and adolescents. According to the World Health Organization (WHO), iron deficiency anemia affects approximately 40% of children under the age of 5 and 30% of adolescents worldwide.

At birth, unless the mother has severe anemia during pregnancy, newborns typically have sufficient iron stores. Breastfed infants are generally protected from iron deficiency for the first six months due to the high bioavailability of iron in breast milk. However, as infants grow, their iron needs increase rapidly, and if they do not receive enough iron-rich foods, they may develop deficiency.

Causes of Iron Deficiency in Children

Iron deficiency in children can result from various factors, including:

• Insufficient dietary intake – Consuming foods low in iron or excessive intake of cow’s milk (>500 ml per day), which can interfere with iron absorption.
• Rapid growth – During infancy and adolescence, the body’s demand for iron increases significantly.
• Frequent infections – Chronic infections (e.g., urinary tract infections) can contribute to iron loss.
• Chronic diarrhea – Conditions such as celiac disease or inflammatory bowel disease can impair iron absorption.
• Parasitic infections – Intestinal parasites like hookworms can cause blood loss, leading to iron deficiency.
• Menstruation in adolescent girls – Due to monthly blood loss, adolescent girls are at higher risk of iron deficiency anemia.
• Gastrointestinal disorders – Conditions like stomach ulcers, Meckel’s diverticulum, polyps, and inflammatory bowel diseases can lead to hidden blood loss.

Symptoms of Iron Deficiency

When iron deficiency progresses to anemia, the following symptoms may appear:

• Fatigue, irritability, and weakness
• Poor concentration and difficulty in learning
• Loss of appetite
• Pale skin, particularly noticeable on the eyelids, palms, and inside the mouth
• Dizziness and headaches
• Brittle hair and nails
• Craving for non-nutritive substances (Pica syndrome – eating soil, paper, or ice)
• Delayed physical and mental development
• Increased susceptibility to infections
• Breath-holding spells – In some children, iron deficiency can lead to episodes where they cry and temporarily stop breathing, turning blue.

Diagnosis

Iron deficiency is diagnosed through blood tests, including:

• Hemoglobin and hematocrit levels
• Serum ferritin levels (a key indicator of iron stores)
• Serum iron and total iron-binding capacity (TIBC)
• Reticulocyte count and peripheral blood smear (to assess red blood cell shape and size)

Treatment of Iron Deficiency in Children

Iron supplementation is the primary treatment, and it is usually administered in the form of:

• Liquid iron supplements (syrup or drops) for infants and young children
• Capsules or tablets for older children and adolescents
• Intravenous iron therapy in severe cases

The most commonly used iron compounds include ferrous sulfate, ferrous gluconate, ferrous fumarate, and ferrous succinate, which are highly absorbable forms of iron. The iron supplement should be taken on an empty stomach or two hours after a meal, preferably with vitamin C-rich foods like orange juice to enhance absorption.

Important Considerations

• Avoid giving iron supplements with milk – Calcium can inhibit iron absorption. If milk is consumed, wait at least 30 minutes before taking iron.
• Iron supplements may cause side effects – Constipation, diarrhea, stomach pain, and nausea are common but usually temporary.
• Dark stools are normal – Iron supplements can darken stool color, which is not harmful.
• Preventing tooth staining – To avoid teeth discoloration, use a dropper or mix the supplement with juice and drink through a straw.
• Treatment duration – Typically, iron therapy lasts three months, followed by reassessment. If hemoglobin levels remain low, further investigation is needed to rule out underlying conditions.

The Consequences of Untreated Iron Deficiency

If left untreated, iron deficiency can have serious long-term effects, including:

• Delayed brain development and learning difficulties
• Lower academic performance
• Increased risk of infections due to weakened immunity
• Fatigue, decreased stamina, and poor growth
• Severe cases may lead to heart complications

Preventing Iron Deficiency in Children

To reduce the risk of iron deficiency, it is essential to:

• Ensure a balanced diet – Include iron-rich foods such as red meat (beef, lamb), liver, eggs, lentils, chickpeas, and iron-fortified cereals.
• Introduce iron supplements if needed – According to WHO, preterm infants should start iron supplementation from 1 month of age, and full-term infants from 4 months, if at risk.
• Monitor menstrual health in adolescent girls – Encourage a diet rich in iron to compensate for menstrual blood loss.
• Screen for underlying conditions – Children with recurrent infections, digestive issues, or poor growth should be evaluated for iron deficiency.

Conclusion

Iron plays a crucial role in brain development, immunity, and overall health. Addressing iron deficiency early ensures optimal growth and cognitive function in children. Parents should remain vigilant about their child’s iron intake and seek medical guidance for proper supplementation when necessary. By incorporating iron-rich foods and maintaining regular check-ups, we can prevent the adverse effects of iron deficiency anemia and support healthier development in children.