Why iron is important for your child
Anaemia is a common health problem in children that is often underdiagnosed, especially when a child is otherwise well. Anaemia means that there is not enough hemoglobin in one's body to transport oxygen to the tissues.
Below is a diagram that explains more about how Haemoglobin (consisting of Haem and a globin protein) acts as an oxygen carrier.
Why do children become anaemic?
A child can be anaemic due to a number of causes for instance Malaria, HIV, worm or parasitic infestations, renal disease, folate deficiency and many other but iron deficiency is the commonest cause and is what I will be focusing on.
A full term, healthy baby receives enough iron from their mother's placenta during pregnancy (unless the mom was deficient herself) to last them until they are six months old and exclusively breastfed. Breastmilk itself is quite low in iron and therefore a delayed introduction in solids or failure to provide necessary supplements may result in an iron deficiency anaemia. Many sources will motivate to even start iron supplementation in a breastfed baby at four months of age. Most formula milks contains iron fortification, this does not however mean that they are superior to breast milk. Cow's milk is also low in iron and is not recommended before one year.
Prevalence among pregnant women and in children younger than 5 years in developing countries can exceed 50 %. Depleted iron stores has been reported in up to 36% of all population groups in South Africa, while the prevalence of iron deficiency anaemia in primary school children can be as high as 83%.
Iron deficiency anaemia has serious consequences in adults and children. Iron deficient women have a higher mortality risk during childbirth and an increased incidence of low birth weight babies. Anaemia can have deleterious consequences on children's performance by lowering their IQ by up to 9 points as well as behavioural problems. Some other symptoms of iron deficiency anaemia in children are:
Pale skin (visible on handpalms, earlobes, and conjunctivae of eyes)
Irritability or fussiness AND poor sleeping habits
Lack of energy or tiring easily (fatigue)
Fast heart beat
Sore or swollen tongue
Wanting to eat odd substances, such as dirt or ice (also called pica)
So, how does one prevent it?
Ensure that you take your iron supplements while you are pregnant. If you weren't iron deficient during pregnancy, your baby will have enough iron to last them until they start solids. Some sources recommend giving your baby iron supplementation when you are breastfeeding for the first six months of life or choosing a iron fortified formula, others recommend only giving it from 4 months, others don't recommend it at all if mom and baby were healthy and solids are not delayed. It would be best to check with your own health care provider. Ensure your baby eats food that are rich in iron and Vitamin C (as Vitamin C also plays a role in iron absorption) - more on that topic later!
If you are concerned that your baby might have an iron deficiency anaemia, it would be best to discuss with your health care worker. We often recommend only testing at 12 months of age but oftentimes it is necessary to test earlier and advise on supplementation, and how much. Toddlers can also be picky eaters especially when it comes to iron containing foods and sometimes restless behaviour and poor sleeping habits, which appear like normal toddler behaviour, may in fact be an iron deficiency anaemia. (unfortunately, not all toddlers with restless behaviour and poor sleeping habits have iron deficiency anaemia, if it was only that simple!)
How is it diagnosed?
An iron deficiency anaemia will be diagnosed on a Full blood count and iron studies. The iron studies are useful to determine the amount of iron stored in the body and carried in the blood. Sometimes the haemoglobin count might still be normal but the iron stores are depleted which would require supplementation. It needs to be interpreted and explained by a doctor.
How is it treated?
It will be treated with iron supplementation. There are numerous ones on the market. For babies, we usually use Vidaylin drops with added iron, and for toddlers, Ferrimed tastes the best:), and another one which I also have good response rates is Spatone sachets, which come in an apple flavour. These are a few of numerous brands. There are different dosages for maintenance treatment and deficiency treatment, once again, check with your health care provider.
It is also good practice to also rule out and treat a worm infestation when an iron deficiency anaemia is diagnosed, as a hookworm can cause small amounts of ongoing blood loss in the gut.
What are good iron rich goods to give to a baby or toddler?
Animal protein are the best source of iron, especially red meat. If you plan to only give your child a plant based diet you HAVE to supplement.
Eggs, fish and chicken also contain iron, but in smaller amounts. Leafy greens and beans as well, but in even smaller amounts- too little to maintain a normal iron level in a growing child.
Once again, if you have any concerns or questions about iron deficiency anaemia, ask your GP or Paediatrician and be vigilant in recognising it.