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Anemia caused by low iron - infants and toddlers

Anemia - iron deficiency - infants and toddlers

Anemia is a problem in which the body does not have enough healthy red blood cells. Red blood cells bring oxygen to body tissues.

Iron helps make red blood cells, so a lack of iron in the body may lead to anemia. The medical name of this problem is iron deficiency anemia.

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Causes

Anemia caused by a low iron level is the most common form of anemia. The body gets iron through certain foods. It also reuses iron from old red blood cells.

A diet that does not have enough iron is the most common cause. During periods of rapid growth, even more iron is needed.

Babies are born with iron stored in their bodies. Because they grow rapidly, infants and toddlers need to absorb a lot of iron each day. Iron deficiency anemia most commonly affects babies 9 through 24 months old.

Breastfed babies need less iron because iron is absorbed better when it is in breast milk. Formula with iron added (iron fortified) also provides enough iron.

Infants younger than 12 months who drink cow's milk rather than breast milk or iron-fortified formula are more likely to have anemia. Cow's milk leads to anemia because it:

• Has less iron
• Causes small amounts of blood loss from the intestines
• Makes it harder for the body to absorb iron

Children older than 12 months who drink too much cow's milk may also have anemia if they do not eat enough other healthy foods that have iron.

Symptoms

Mild anemia may have no symptoms. As the iron level and blood counts become lower, your infant or toddler may:

• Act irritable
• Become short of breath
• Crave unusual foods (called pica)
• Eat less food
• Feel tired or weak all the time
• Have a sore tongue
• Have headaches or dizziness

With more severe anemia, your child may have:

• Blue-tinged or pale whites of eyes
• Brittle nails
• Pale skin color

Exams and Tests

The health care provider will perform a physical exam. All babies should have a blood test to check for anemia. Blood tests that measure iron level in the body include:

• Hematocrit
• Serum ferritin
• Serum iron
• Total iron binding capacity (TIBC)

A measurement called iron saturation (serum iron/TIBC) often can show whether the child has enough iron in the body.

Treatment

Since children only absorb a small amount of the iron they eat, most children need to have 8 to 10 mg of iron per day.

DIET AND IRON

During the first year of life:

• Do not give your baby cow's milk until age 1 year. Babies under age 1 year have a difficult time digesting cow's milk. Use either breast milk or formula fortified with iron.
• After 6 months, your baby will start to need more iron in their diet. Start solid foods with iron-fortified baby cereal mixed with breast milk or formula.
• Iron-rich pureed meats, fruits, and vegetables can also be started.

After age 1 year, you may give your baby whole milk in place of breast milk or formula.

Eating healthy foods is the most important way to prevent and treat iron deficiency. Good sources of iron include:

• Apricots
• Chicken, turkey, fish, and other meats
• Dried beans, lentils, and soybeans
• Eggs
• Liver
• Molasses
• Oatmeal
• Peanut butter
• Prune juice
• Raisins and prunes
• Spinach, kale and other greens

IRON SUPPLEMENTS

If a healthy diet does not prevent or treat your child's low iron level and anemia, the provider will likely recommend iron supplements for your child. These are taken by mouth.

Do not give your child iron supplements or vitamins with iron without checking with your child's provider. The provider will prescribe the right kind of supplement for your child. If your child takes too much iron, it can cause poisoning.

Outlook (Prognosis)

With treatment, the outcome is likely to be good. In most cases, the blood counts will return to normal in 2 months. It is important that the provider find the cause of your child's iron deficiency.

Possible Complications

A low iron level can cause decreased attention span, reduced alertness and learning problems in children.

A low iron level can cause the body to absorb too much lead.

Prevention

Eating healthy foods is the most important way to prevent and treat iron deficiency.

References

Baker RD, Baker SS. Infant and toddler nutrition. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Disease. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 85.

Powers JM, Brandow AM. Pallor and anemia. In: Kliegman RM, Toth H, Bordini BJ, Basel D, eds. Nelson Pediatric Symptom-Based Diagnosis. 2nd ed. Philadelphia, PA: Elsevier; 2023:chap 49.

Rothman JA. Iron-deficiency anemia. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 504.

Review Date: 2/17/2024  

Reviewed By: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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