Iron deficiency anemia is a decrease in the number of red blood cells, caused by a lack of iron. This article focuses on iron deficiency anemia in children.

Iron deficiency anemia is the most common form of anemia. Iron is an essential part of hemoglobin, the oxygen-carrying protein in blood. Iron comes from the diet and by recycling iron from old red blood cells.

Babies are born with about 500 milligrams (mg) of iron in their bodies. By the time they reach adulthood they need to have about 5,000 mg.

Children need to absorb an average of 1 mg per day of iron to keep up with the needs of their growing bodies. Since children only absorb about 10% of the iron they eat, most children need to ingest 8-10 mg of iron per day. Breast-fed babies need less, because iron is absorbed 3 times better when it is in breast milk.

An iron-poor diet is a common cause of iron deficiency. Drinking too much cow's milk is a common cause of iron deficiency in young children because cow’s milk contains little iron and can get in the way of iron absorption. Cow's milk also can cause problems in the intestine that lead to blood loss and increased risk of anemia.

A common time for iron deficiency is between 9 - 24 months old. All babies should have a screening test for iron deficiency at this age. Babies born prematurely may need to be tested earlier. The adolescent growth spurt is another high-risk period.

Iron deficiency in children can also be related to lead poisoning.

• Pale skin color (pallor)
• Fatigue
• Irritability
• Weakness
• Shortness of breath
• Sore tongue
• Brittle nails
• Unusual food cravings (called pica)
• Decreased appetite (especially in children)
• Headache
• Blue-tinged or very pale sclerae (whites of eyes)

Note: There may be no symptoms if anemia is mild.

• Low hematocrit and hemoglobin levels
• Small red blood cells
• Low serum ferritin level
• Low serum iron level
• High iron binding capacity (TIBC) in the blood
• Blood in stool

Oral iron supplements are in the form of ferrous sulfate. Iron supplements are best absorbed on an empty stomach, but many people are unable to tolerate them and may need to take them with food. Milk and antacids can interfere with iron absorption and should not be taken at the same time as iron supplements. Vitamin C can increase absorption and is needed for the production of hemoglobin.

Supplemental iron is needed during pregnancy and breast-feeding because diet alone rarely supplies the needed amount.

The hematocrit should return to normal after 2 months of iron therapy, but continue taking iron supplements for another 6 to 12 months. This will replenish the body's iron stores, which are contained mostly in the bone marrow.

Intravenous or intra-muscular iron is available for people who can't tolerate oral iron supplements.

Iron-rich foods include raisins, meats (liver is the highest source), fish, poultry, egg yolks, legumes (peas and beans), and whole-grain bread.

Iron supplementation improves learning, memory, and cognitive test performance in iron-deficient adolescents. Iron supplementation also improves the performance of iron-deficient, anemic athletes.

With treatment, the outcome is likely to be good. In most cases the blood counts will return to normal in 2 months.

Iron deficiency (even when not enough to cause anemia) is an important cause of decreased attention span, alertness, and learning -- both in young children and in adolescents. Iron deficiency anemia can affect school performance.

Diet is the most important way to prevent and treat iron deficiency. Many foods are good sources of iron:

• Good sources include tuna, oatmeal, apricots, raisins, spinach, kale, greens, and prunes.
• Better sources include eggs, meat, fish, chicken, turkey, soybeans, dried beans, peanut butter, peas, lentils, and molasses.
• The best sources are breast milk (the iron is very easily used by the child), formula with iron, infant cereals, other iron-fortified cereals, liver, and prune juice.

In addition, restrict milk to no more than 24 ounces a day. If the diet is deficient in iron, iron supplements should be taken by mouth. Your doctor may recommend increased amounts of iron during periods of increased requirements, such as teen pregnancy and breastfeeding.