Written by Registered Dietitian Nishti
Red blood cells contain a protein called haemoglobin. Haemoglobin has the important function of delivering oxygen to the body and iron is the component in haemoglobin that allows the red blood cells to carry oxygen. Iron is therefore an essential part of haemoglobin. If the body doesn’t have enough iron, haemoglobin will struggle to carry oxygen around which can lead to iron deficiency anaemia (IDA).
In this blog, you are going to learn what causes IDA and some of the common symptoms seen in children.
In our clinic, we see both children and parents with IDA. This blog focuses on IDA in children, but we do have another blog that gives a broad overview of everything you need to know about iron. Please click here to read.
Why is iron important for children?
Around 40% of children aged between 6 months and 4 years struggle with IDA. It is therefore not uncommon to see IDA in children.
For babies born full term and who have a healthy weight (>3kg) not much iron is required up until around 6 months of age. This is because term babies are usually born with enough iron stores to see them through up until it’s time to start solids. Breastmilk may contain very small amounts if iron but has an absorption rate of around 50% which is very high. Formula milk contains much more iron in comparison to breastmilk, however, the absorption is very low. Regardless of whether your baby is breast or formula fed, the advice is the same: start solids when your child is ready (a baby can start eating from 17 weeks if they are ready). Speak to your doctor or dietitian first.
Symptoms of iron deficiency in children
Below is a list of typical symptoms seen in children with IDA.
- Low appetite
- Strange food cravings like eating dirt or other non-food matter
- Failure to grow at the expected rate
- Tiredness
- Pale Skin
- Lethargy & lack of concentration
- Breathlessness
- Repeat infections (often sick)
- Mental effects (impaired cognitive performance and psychomotor development).
Causes of iron deficiency in children
Some children are at higher risk of IDA because of certain factors such as:
- Prematurity and low birth weight
- Exclusive breastfeeding beyond six months and not introducing solids
- High intake of cow’s milk in young children less than two years of age
- Low intake of iron-rich foods such as meat, poultry, tofu, beans, and green vegetables
- Poorly balanced vegetarian and /or vegan eating
- An undiagnosed chronic condition such as coeliac disease.
How much iron does a child need?
| Age group | Daily requirement (mg) |
| Children aged 7-12 months | 7.8 |
| Children aged 1-3 years | 6.9 |
| Children aged 4-6 years | 6.1 |
Iron-rich foods
Iron-rich foods are present in many foods but some are considered more bioavailable than others. Please refer to this blog that explains more about haem and non-haem iron.
| Food | Portion | Amount of iron (mg) |
| Beef/lamb | 25g | 0.7 |
| Dark turkey | 25g | 0.3 |
| Salmon | 100g | 0.5 |
| Egg | 1 whole | 1 |
| Tofu | 50g | 1.75 |
| Baked beans | 100g | 1.4 |
| Weetabix | 1 biscuit | 2.2 |
| Ready Brek | 30g | 3.6 |
| Wholemeal bread | 1 slice | 1.0 |
| Broccoli | 2 tbsp | 0.3 |
| Kale | 50g | 1.0 |
| Dried apricot | 5 pieces | 0.8 |
How to improve iron absorption
Include foods and drinks rich in Vitamin C at each meal as Vitamin C helps to absorb the iron from food.
Good sources of Vitamin C include:
- Citrus fruits – oranges, mandarins, lemons, grapefruit, tomato.
- Fruit juices – citrus fruits and other juices, drinks with added vitamin C, e.g., blackcurrant squash.
- Vegetables – cook for as short a time as possible in a minimum of water or eat raw.
Cow’s milk is an iron-poor food
Cow’s milk is very low in iron.
A serving of 240ml (8oz) cow’s milk provides 0.07mg of iron which is only 1% of the daily recommended intake of iron. To put it into context for you, 1 apricot contains more iron (0.2mg).
The impact of cow’s milk on iron balance extends beyond its low iron content—it also interferes with the absorption of iron. Both the proteins and other nutrients in milk negatively affect iron bioavailability. Meaning, too much cow’s milk can cause iron deficiency anaemia in children. Toddlers relying on milk (or any iron-poor food) for a significant portion of their diet consume a large percentage of their daily calories from an iron-poor source and may miss opportunities to include foods richer in iron. For children over 1 year of age, please ensure they don’t have more than 600ml of cow’s milk per day.
Preventing iron deficiency anaemia in children
- You can avoid IDA in your child by making sure you start weaning them when they show readiness to start eating (no later than 6 months and no sooner than 17 weeks).
- For children over 1 year: If having cow’s milk, limit this to no more than 600ml/day as a precaution. Too much milk reduces their appetite for food and too much milk may cause IDA.
- Aim for at least 3 servings of iron-rich foods per day (i.e. green leafy vegetables, fortified breakfast cereals, tofu, beans, and pulses or meats.)
- Pair the iron-rich foods with a source of vitamin C to increase the absorption of iron.
- If you think your child is not eating enough iron-rich foods, consider a multivitamin with iron.
Iron and our genetics
Research shows that the iron status in an individual is influenced by a combination of genetics, dietary and lifestyle factors. For example, several genes can impact the risk of having low iron status, including TMPRSS6, Transferrin Teceptor 2 and Transferrin.
For example, The TMPRSS6 gene provides instructions for making a protein called matriptase-2. This protein is part of a signaling pathway that controls the levels of another protein called hepcidin, which is a key regulator of iron balance in the body. When blood iron levels are low, this signaling pathway reduces hepcidin production, allowing more iron from the diet to be absorbed through the intestines and transported out of storage sites into the bloodstream. Any variations in the TMPRSS6 gene can alter this feedback loop between matripase-2 and hepcidin, causing a higher risk of iron deficiency in some people. This highlights the impact our genes have on our nutritional status. Nishti eplains more about iron and genetics in this video.
Here at Nishti’s Choice, we provide genetic testing analysis which helps to determine your risk for low iron status. Is it not a blood test! The test is very non-invasive (mouth swab) and provides you with details about the above-mentioned genes. To hear more or to book a no-obligation chat please visit the booking page.
References:
Fewtrell, Mary et al. “Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition.” Journal of pediatric gastroenterology and nutrition vol. 64,1 (2017): 119-132.
Gedfie, Solomon et al. “Prevalence and Associated Factors of Iron Deficiency and Iron Deficiency Anemia Among Under-5 Children: A Systematic Review and Meta-Analysis.” Global pediatric health vol. 9
McCance and Widdowson’s. The Composition of Foods. 4th edition.
Pichler, Irene et al. “Identification of a common variant in the TFR2 gene implicated in the physiological regulation of serum iron levels.” Human molecular genetics vol. 20,6 (2011): 1232-40.