Around 75% of babies aged six to 12 months and 25% of children aged one to two years in Australia do not receive the recommended dietary intake of iron.
Despite their small size, babies and weaning children need similar amounts of iron to adults. Iron is crucial for supporting rapid blood and muscle growth, immunity, brain development and learning.
Untreated iron deficiency can progress to severe iron deficiency anemia, where there is insufficient healthy red blood cells to carry oxygen around the body. Alarmingly, anemia affects around 8% of Australian children under five and, if left untreated, can be associated with developmental delays and later cognitive deficits.
Read more: Why iron is such an important part of your diet
How do I know if my children are iron deficient?
Iron deficiency in children is often associated with vague or no symptoms, especially if it has not progressed to anemia.
Symptoms may include fatigue, difficulty concentrating, poor behavior, frequent infections and pica (eating non-food substances such as paper, clay or earth).
Diagnosis typically involves a blood test that screens for markers of iron, such as ferritin, a protein that stores iron. Doctors often recommend these tests for high-risk people, detailed in the figure below.
What are the first treatment options?
When iron deficiency and anemia are caused by a lack of iron in the diet, both can often be treated effectively through dietary changes and oral iron supplements.
The Royal Childrens Hospital in Melbourne recommends increasing your intake of iron-rich foods such as meat, fish, eggs, leafy greens and legumes, and drinking less than 500mL (about two cups) of cow’s milk per day. This is because cow’s milk has been linked to reduced iron stores in young children.
Doctors may also prescribe oral iron supplements. A course of liquids or tablets would normally be recommended for a minimum of three months, during which time follow-up blood tests can show how well the child is responding to supplementation.
Existing evidence suggests that supplements are a more effective way to replenish iron stores than dietary changes alone, and ferrous sulfate is the most effective iron supplement for young children.
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Navigating Side Effects
Iron supplements are known to have some unpleasant side effects, including constipation, nausea, diarrhea, dark stools and stained teeth. This can make compliance a challenge, especially for young children. Approaches to relieving side effects vary depending on the child.
Your doctor may recommend alternative supplements, as some may be better tolerated than others. Another option is to adjust the dosage, with supplements in smaller doses or on alternate days.
Taking iron supplements with food or immediately after eating may also decrease side effects. However, this may result in reduced absorption and should be discussed with your doctor.
In cases where iron supplements don’t seem to work or where adherence is an issue, iron infusions may be prescribed by your doctor. These involve injecting iron over multiple visits to a hospital and/or specialist clinic, with each session potentially lasting an hour or more.
Read more: I was diagnosed with iron deficiency, what now?
How can I prevent iron deficiency in my children?
To prevent iron deficiency, it is important to pay attention to your child’s iron intake and the factors that may influence its absorption.
For example, drinks containing tannins (tea, coffee, chocolate) can inhibit iron absorption. But vitamin C and organic acids from fruits and vegetables, as well as high-quality proteins like those found in meat and fish, can promote absorption.
From infancy onwards, following national dietary guidelines will help maintain your child’s iron level. This includes introducing iron-rich solid foods from six months of age to healthy breastfed babies to replenish their iron stores from birth.
Around six months is also a prime time to introduce foods that minimize the risk of food allergies, including iron-rich foods like seafood and nut butters.
From 12 months onwards, children’s diets should be aligned with the Australian Dietary Guidelines, emphasizing a balanced and nutritious diet, covering a variety of foods. Diets that follow this pattern should provide plenty of iron from meats, breads and cereals, as well as iron absorption promoters such as oranges, peppers and other fresh fruits and vegetables.
In cases where the child is a picky eater or where access to a variety of foods is limited, look for iron-fortified options such as breads, drinks (e.g., juice for children over 12 months and Milo for older children). ) and Breakfast Cereals.
If your child is diagnosed with iron deficiency, remember that each path to recovery is unique. Consultation with a family doctor or nutritionist can help tailor solutions that meet your specific needs.
Read more: What to drink for dinner to get the most iron from your food (and what to avoid)
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