Anemia in Children

Posted on Wed, Aug. 17, 2005

By Dr. Keith White

AN 18-MONTH-OLD boy came into our emergency room recently, suffering from a few days of diarrhea. He looked tired and pale, so the doctor ordered a blood test for anemia, a condition of reduced red blood cells that carry oxygen, which can be caused by iron deficiency.

The boy's red blood count was half the normal amount. It turned out he was severely iron deficient, because his diet consisted mainly of milk, which does not supply enough iron for normal growth and development.

And, in infants, cow's milk can actually cause slow stomach bleeding, so should not be given to infants under a year old. His parents didn't realize that, though milk or milk products are important in a child's diet, they aren't enough.

The boy's diarrhea, caused by a temporary viral infection, was probably unrelated to his iron deficiency. Thanks to the alertness of the ER doctor, though, the boy's iron deficiency and anemia were easily treated with an iron supplement. His blood count soon came back to normal.

Testing for anemia is one way to screen for iron deficiency, and it worked in this boy's case because his deficiency was severe. But tests for anemia catch only extreme iron deficiency, so many toddlers (children, ages 1 to 3 years) are not diagnosed.

I recently did a study, published in the February issue of the medical journal Pediatrics, that shows that the tests for anemia miss two-thirds of children who have iron deficiency. Even a child with a normal red blood count (that is, who is not anemic) may not be getting enough iron.

Many parents don't know their children are iron deficient, which could have serious health consequences. About 750,000 toddlers in the U.S. are deficient in iron. The long-term effects of iron deficiency are still being studied, but evidence indicates that the nutrient is important for developing a healthy brain. A lack of iron could lead to emotional and behavioral problems and lower IQs. Children with anemia are more likely to be in special education classes in school than non-anemic children.

I am concerned that too many doctors rely on anemia as the only indication of iron deficiency. About 30 years ago, iron deficiency was the most common cause of anemia in children. Then baby formula was fortified with iron and the frequency of anemia among newborns to 1-year-olds dropped dramatically.

But today, toddlers still have the highest rate of iron deficiency, along with women in their reproductive years. About 9 percent of the general toddler population is iron deficient. Among Latino toddlers, it is 18 percent.

It's important to give every child iron-rich foods, such as iron-fortified breakfast cereals (check the label), iron-enriched pasta, and meats.

But even a good diet doesn't guarantee that your child is getting the recommended daily amount of iron. Many children need iron supplements or children's vitamins with iron.

Parents should speak with their child's physician or nurse practitioner about the possibility of iron deficiency in their child, testing for iron deficiency and giving an iron supplement.

A modest supplement of 10 milligrams of iron a day can make a difference. Do not exceed the recommended daily amount, though, because there can be side effects, and too much iron is dangerous.

White is a pediatrician at Contra Costa Regional Medical Center in Martinez.