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Preventing Iron Deficiency Anemia

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Iron deficiency is still a big problem today. In fact, the World Health Organization lists iron deficiency as one of the 'Top Ten Risk Factors Contributing to Death'.

Other facts about iron deficiency:

  • As many as 4-5 billion people, 66-80% of the world’s population, may be iron deficient
  • 2 billion people – over 30% of the world’s population – are anemic, mainly due to iron deficiency
  • In total, 800,000 (1.5 percent) of deaths worldwide are attributable to iron deficiency

Surprisingly, iron deficiency anemia is not just a problem in developing countries of the world. According to the CDC, 'although iron deficiency is more common in developing countries, a significant prevalence was observed in the United States during the early 1990s among certain populations, such as toddlers and females of childbearing age.'

In one study, 7% of toddlers aged 1-2 years and 9-16% of adolescent and adult females aged 12-49 years were found to have iron deficiency.

Also at risk are premature babies who are born with low stores of iron in their bodies.

Although the incidence of childhood iron-deficiency in the United States has been decreasing and iron deficiency anemia is uncommon, we are still above the Healthy People 2010 objectives of 5%, 1%, and 7% for toddlers, preschool children, and females aged 12--49 years, respectively.

Why is battling iron deficiency important?

Because 'iron deficiency anemia significantly impairs mental and psychomotor development in infants and children,' leading to developmental delays and behavioral disturbances. It can also increase the risk for a preterm delivery and delivering a low-birthweight baby in pregnant women who are iron deficienct.

Prevention of Iron Deficiency
in Infants and Toddlers

It can help to understand how to prevent iron deficiency if you understand how the body stores iron. Babies, unless they are born premature, are born with all of the iron they need for the first 5-6 months of life. After that, unless they are given an iron supplement, they can develop iron deficiency, which means that they don't have enough iron in their body. If it continues, it will then lead to iron deficiency anemia.

So to prevent iron deficiency, you should breastfeed or give your infant an iron fortified infant formula (avoiding low iron formula) until they are at least 12 months of age, and begin an iron supplement by about 6 months of age.

Starting an iron supplement doesn't necessarily mean starting them on a vitamin with iron though. The usual supplement is simply an iron fortified infant cereal given once or twice a day. Remember that preemies or low birth weight infants do usually also need a vitamin with iron.

After you have introduced an iron fortified infant cereal, start one feeding a day of foods rich in vitamin C (e.g., fruits, vegetables, or juice) to improve iron absorption, preferably with meals.

Causes of Iron Deficiency

It is now easy to see why some infants develop iron deficiency, which is usually because they aren't getting enough iron. However, other causes or iron deficinecy can include blood loss and impaired absorption of iron, although that is rare.

Most kids become iron deficient because they aren't getting:

  • breastmilk or an iron fortified infant formula until 12 months
  • an iron supplement after 6 months
  • a vitamin with iron if they were born premature or low birth weight

or if they are getting cow's milk or goat's milk before 12 months, instead of breastmilk or formula.

Unlike breastmilk and iron fortified formula, cow's milk and goat's milk have minimal amounts of iron in them and they are poorly absorbed. Cow's milk may also cause younger infants to have some gastrointestinal bleeding, which makes it even more likely that they will develop iron deficiency anemia.

Toddlers who drink more than 16-24 ounces of milk are also at risk for developing iron deficiency. In addition to not having much iron in it, cow's milk decreases how well your body absorbes iron from other foods. And toddlers who are drinking a lot of milk are likely getting filled up and probably aren't eating a lot of foods with iron in it anyway.

Because preschool and younger school age children are not going through periods of rapid growth and they have lower ron requirements, they are not at big risk of iron deficiency.

The risk does go up again during the teens years, because they are growing rapidly and have increased iron requirements. Girls who have started their periods, especially if they have heavy menstrual blood loss, are also at increased risk of iron deficiency.

Prevention of Iron Deficiency in Teens

To prevent iron deficiency in teens, they should be encouraged to eat iron-rich foods and foods that enhance iron absorption. Those who are at risk of becoming iron deficient should be tested and given an iron supplement if they do have iron deficiency.

Screening for Iron Deficiency

The CDC recommends that children who are at high risk for iron-deficiency anemia should be tested for anemia between ages 9 and 12 months, 6 months later, and annually from ages 2 to 5 years.

It is also recommended that, starting in adolescence, you should screen all nonpregnant women for anemia every 5-10 years throughout their childbearing years during routine health examinations, annually for women having risk factors for iron deficiency, and at the first prenatal care visit if they are pregnant.

The American Academy of Pediatrics recommends screening by 9 months of age and again between ages 11 and 21 years for all menstruating teens.

No routine screening for iron deficiency is recommended for teen boys.

Treatment of Iron Deficiency

In addition to improving the child's diet, treatment of iron deficiency involves giving the child an iron vitamin. For infants and younger children, this usually means prescribing 3 mg/kg per day of iron drops to be administered between meals divided once or twice a day.

Adolescent girls and women who have anemia are usually prescribed an oral dose of 60-120 mg/day of iron.

Foods that are Good Sources of Iron

  • Meats -- beef, pork, lamb, and liver and other organ meats
  • Poultry -- chicken, duck, and turkey, especially dark meat; liver
  • Fish -- shellfish, like clams, mussels, and oysters; sardines; anchovies; and other fish
  • Leafy greens of the cabbage family, such as broccoli, kale, turnip greens, 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-enriched white bread, pasta, rice, and cereals. Read the labels.

Important disclaimer: The information on is for educational purposes only and should not be considered to be medical advice. It is not meant to replace the advice of the physician who cares for your child. All medical advice and information should be considered to be incomplete without a physical exam, which is not possible without a visit to your doctor.

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