Your child can be low in iron long before you realize anything is wrong. Iron deficiency does not always begin with obvious symptoms, and it can develop before your child becomes anemic. Because iron plays an important role in brain development, energy and healthy growth, getting enough of it is especially important throughout childhood and adolescence.
“I see iron deficiency all the time. It's one of the most common nutritional deficiencies that we see as pediatricians. Iron is so important because it plays such a crucial role in brain development, energy and just overall growth in children,” says Rakibul Akter, MD, a pediatrician at Children’s Memorial Hermann Pediatrics.
Fortunately, iron deficiency is both preventable and treatable. Knowing which children are at greater risk, recognizing potential symptoms and talking with your pediatrician can help make sure your child is getting the iron they need.
Where Children Can Get Iron
Iron's role in producing healthy red blood cells is important for health throughout life, but it is especially important in childhood because your child is continually growing and developing. Many children can get the iron they need through food. Common sources include:
- Red meat, beef and poultry
- Eggs
- Iron-fortified infant cereals
- Lentils
- Green vegetables like spinach, broccoli, green beans and asparagus
Diet becomes particularly important during periods of rapid growth, when the body's nutritional demands may increase. Unfortunately, iron deficiency is common in both children and adolescents. “Iron deficiency can actually occur before your child develops anemia,” Dr. Akter explains. “This means that your child can have low iron stores in the body without it affecting their blood counts or their hemoglobin yet.”
How Iron Needs Change as Kids Grow
Your child may also have few or no noticeable symptoms of iron deficiencies during the early stages. This is one reason why pediatricians consider both your child's age and individual risk factors when determining whether screening may be appropriate. Certain stages of childhood deserve particular attention.
Infants
For breastfed infants, iron can become a concern beginning around four to six months of age. “Breast milk is great for babies, but it does have low iron content. It only provides sufficient iron content for about the first four months,” Dr. Akter says.
This is around the time parents begin introducing complementary foods, including iron-fortified infant cereals, pureed meats, eggs and vegetables. Dr. Akter says iron supplementation may also be recommended for breastfed babies during this period.
He notes that premature infants can have a greater risk of iron deficiency and may need supplementation earlier. You should talk with your pediatrician about when and how much iron your baby needs rather than beginning supplementation on your own.
Toddlers
Toddlerhood introduces a different challenge: picky eating. A child who suddenly refuses many of the foods they previously ate may not consume enough iron-rich foods. During toddlerhood, you should aim for your child to have three servings of iron-rich foods each day. Dr. Akter notes you should also pay attention to what your toddler is drinking.
After children transition from breast milk or formula to cow's milk, drinking too much milk can interfere with iron intake and absorption. Furthermore, if your toddler fills up on milk throughout the day, they may be less interested in eating iron-rich foods. “As a general rule, after a child turns a year old, you can introduce cow's milk but try to limit it to a maximum of 20 ounces per day,” Dr. Akter cautions.
Teenage Girls
Iron needs can become important again during adolescence, particularly for girls who have begun menstruating. Menstrual bleeding results in regular iron loss, which can increase the risk of deficiency. Additionally, rapid growth and dietary habits can add to that risk.
Because iron deficiency can exist before anemia develops or noticeable symptoms appear, Dr. Akter says screening can help identify adolescents who may otherwise not know their iron levels are low.
The Signs of Iron Deficiency in Children
Iron deficiency can be difficult for you to recognize if your child does not initially have symptoms. As iron levels continue to decline and potentially progress to anemia, changes may become more noticeable. Potential signs can include:
- Low energy
- Pale skin
- Dizziness, particularly when standing up
- Difficulty concentrating
- Shortness of breath, which may be more noticeable in teenagers and athletes
Parents may also notice less obvious symptoms, such as pica, which is an intense craving for or consumption of items that are not typically considered food. For example, a child might crave ice, dirt or even paper. Dr. Akter says pica can be particularly noticeable in toddlers.
Another potential clue is restless sleep. “We see restless sleep a lot in toddlers and adolescents, where they're kicking and having restless legs at night,” explains Dr. Akter. “So, if your child is experiencing poor sleep, we'll actually check for low iron storage levels, because there's a big correlation between the two.”
These symptoms do not automatically mean your child is iron deficient. But changes in energy, appearance, sleep, appetite or concentration are worth mentioning to your pediatrician, particularly when they occur alongside dietary or other risk factors.
Diagnosing and Treating Iron Deficiency
If your pediatrician suspects your child has iron deficiency, screening typically involves a blood draw. Blood counts, hemoglobin and iron markers can help provide a clearer picture of your child's iron status.
Treatment depends on your child and the severity of their deficiency, but dietary changes are an important starting point. Iron-rich foods can also be paired with foods containing vitamin C, such as oranges, strawberries and tomatoes, because that vitamin helps the body absorb iron more effectively.
If your child needs additional treatment, a pediatrician may recommend an oral iron supplement. “It’s so important that a child with iron deficiency gets the appropriate daily dose based on their weight,” Dr. Akter says. “This is why it is important for a parent or caregiver to work with a pediatrician to address their child’s needs rather than simply choosing an over-the-counter supplement.”
Iron supplements can cause constipation or an upset stomach and may make stools appear darker. Your pediatrician may repeat bloodwork over the following one to three months to make sure iron and hemoglobin levels are improving.
Once lab results return to normal, supplementation may continue for a short period to help rebuild the body's iron stores before the focus shifts back to maintaining healthy levels through diet.
One thing Dr. Akter points out is that an iron supplement is not the same as a multivitamin. While some children's multivitamins contain iron, others do not. And even when iron is included, Dr. Akter says the amount is typically much lower than the dose used to treat an iron deficiency.
A multivitamin may be helpful for a picky eater because it can provide a broader range of nutrients. However, an iron supplement recommended to address a deficiency has a different purpose: delivering enough iron to restore depleted levels.
“Multivitamins containing iron are intended for preventative maintenance, but when you have a true iron deficiency, you need a higher treatment dose to allow you to get back to normal,” Dr. Akter explains.
As parents, you should talk with your child's pediatrician before using an iron supplement to determine whether it is needed and what dose is appropriate.
Pay Attention to Changes in Your Child
Regular pediatric visits can help identify nutritional concerns, but as parents you have an important perspective that cannot be captured by a blood test or growth chart alone. “Having a good relationship with your pediatrician is important because, even though they know your child from a medical perspective, at the end of the day, you as a parent know your children the best,” Dr. Akter says.
If your child seems unusually tired, looks paler than normal, develops unusual cravings or is eating a less varied diet, bring those observations to your pediatrician. They can consider what you're seeing at home alongside your child's diet, growth, medical history and a physical exam to determine whether additional testing is appropriate.
“Iron deficiency is common, but it is also highly manageable,” Dr. Akter says. “Identifying it early can help give children the iron they need to grow, develop and thrive.”
