What happens when kids are low on iron?

Anaemia is when you don’t have enough red blood cells or when the blood cells don’t have enough haemoglobin.

You need red blood cells and haemoglobin to carry oxygen around your body. If you don’t have enough red blood cells or haemoglobin, your body doesn’t get the oxygen it needs and you can feel tired and irritable.

Iron-deficiency anaemia

The most common type of anaemia in children is iron-deficiency anaemia. Iron-deficiency anaemia happens because of a lack of iron, which your body needs to make haemoglobin.

Iron deficiency in babies
Babies might get iron-deficiency anaemia if they aren’t getting enough iron from their diets.

This can happen if babies are exclusively breastfed beyond 6 months of age or they don’t get enough iron-rich foods when they start eating solids.

Iron deficiency anaemia can also be an issue for babies:

who were born prematurely
who are twins or other multiples
who were very sick as newborns
whose mothers were iron deficient during late pregnancy.

Iron deficiency in older children and teenagers
A lack of iron in the diet is also the most common cause of iron-deficiency anaemia in children and teenagers. This can happen if they:

drink more than 500 ml of cow’s milk a day, especially when they’re toddlers
drink tea
don’t eat enough foods with iron – for example, if they eat a vegetarian diet that isn’t carefully planned
have a condition like coeliac disease, which stops the body from absorbing iron from food very well.

Iron deficiency can also be caused by blood loss. This means that adolescent children who have frequent, long or very heavy periods can be at risk of iron-deficiency anaemia.

Other types of anaemia

If your child isn’t getting enough vitamin B12 or folate from their diet, your child might get vitamin-deficiency anaemia.

Another type of anaemia is haemolytic anaemia. This is when the body destroys too many red blood cells. It sometimes happens because of things like an infection or some medicines. Sometimes it’s caused by inherited conditions – for example, sickle cell anaemia or thalassemia.

Anaemia symptoms

Symptoms of anaemia include:

pale skin
tiredness and irritability
difficulty concentrating and thinking
poor appetite
a craving for unusual things to eat, like ice, chalk and dirt.

Sometimes children might have other symptoms, including:

poor growth
shortness of breath
a fast heart rate.

Does your child need to see a doctor about anaemia symptoms?

Yes. You should take your child to the GP if your child:

looks very pale
is irritable
doesn’t have much energy
complains of frequent headaches
isn’t putting on enough weight or is a fussy eater
drinks a lot of cow’s milk
wants to eat dirt, ice, chalk or other non-food items.

Tests for anaemia

If your GP thinks your child might have anaemia, they’ll usually order blood tests to work out what’s causing it. Often, children have blood tests for other conditions and anaemia shows up on the test results.

Sometimes your GP might try diet changes or supplements first to see whether the symptoms resolve. This might be a good option if your child doesn’t like blood tests.

Some children might be referred to a paediatrician or a haematologist for further tests.

Treatment for anaemia

Anaemia treatment depends on the cause.

Changes to diet for iron-deficiency anaemia
If your child has anaemia caused by a lack of iron, adding iron-rich foods to your child’s diet can boost iron levels.

Red meat is the best source of iron. For children and teenagers who eat vegetarian diets, other good sources of iron include:

wholegrains and iron-fortified cereals
legumes – for example, lentils and beans
egg yolk
dark green, leafy vegetables – for example, spinach
crushed sesame seeds – for example, tahini or halva.

Iron supplements for iron-deficiency anaemia
Your child is likely to need iron supplements (tablets or syrup) to get their iron levels within a healthy range. If your child is taking iron supplements, it’s good for them to eat an orange at the same time as they take their supplement. This is because vitamin C in foods like oranges boosts iron absorption.

Iron supplements might stain your child’s teeth, so it’s a good idea for them to brush straight after taking their supplement. Iron supplements can also turn your child’s poo black or grey and might cause constipation or stomach upsets. Talk to your doctor about how to manage these side effects.

Very rarely, your child might need an infusion or injection of iron.

Children who have started having periods might need iron supplements around the time of their periods. If your child has very heavy periods, your doctor might also recommend treatments to reduce bleeding.

Other causes of anaemia
If the anaemia is caused by something other than iron deficiency, your child might need other treatments.

You should store all iron supplements in a locked cupboard away from children. Iron overdose in a child can be fatal.

Preventing anaemia

Babies
When you’re introducing solid foods to your baby’s diet at around 6 months of age, it’s best to include plenty of iron-rich foods.

You can introduce pasteurised, unflavoured, full-fat cow’s milk to your baby’s diet after 12 months of age. But try to limit the amount of cow’s milk your child drinks to no more than 500 ml a day. Using a cup instead of a bottle can help to reduce the amount of cow’s milk your child drinks.

Children and teenagers
As your child grows, offer them plenty of healthy, nutritious food from the five food groups. A balanced diet can help to prevent anaemia caused by not enough iron, folate or vitamin B12.

Your child should avoid tea, and check with your health professional about giving your child herbal teas. Keep limiting cow’s milk to no more than 500 ml a day.

You can read more about choosing good food for children and teenagers in these articles:

You can increase iron absorption from food by eating vitamin C-rich foods at the same time as iron-rich foods. Vitamin C-rich foods include citrus fruits, strawberries and kiwi fruit.

ABOUT CAUSES DIAGNOSIS TREATMENT NEXT STEPS

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.

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) advises feeding your baby 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.

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)

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 your child has a risk factor 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 (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 will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

To prevent iron-deficiency anemia, the AAP says:

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

Iron-deficiency anemia may cause delayed growth and development.

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

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 about iron-deficiency anemia in children

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.

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.