Iron Deficiency

Infants and toddlers have the greatest risk of iron deficiency. Severe iron deficiency causes anaemia and sometimes developmental problems. Poor dietary iron is the main cause, and unfortunately symptoms and signs of iron deficiency are absent unless there is anaemia. The ingestion of large amounts of cow’s milk after 12 months is the main contributory cause. More than 500mls per day is a risk factor for Fe deficiency.  

What is Iron important for?iron-deficiency

Iron (Fe) is an essential mineral for haemoglobin, which is the main protein molecule that carries oxygen. Haemoglobin is in red blood cell and gives blood its rich red colour. Lack of Fe results in anaemia (low levels of haemoglobin or red cells). Fe is also essential in many biochemical processes throughout the body, including the brain. In some cases developmental and cognition can be impaired in those with iron deficiency

How do we get iron ?

At birth there are adequate iron stores for several months. The exception to this is preterm or small infants, or if the Mother has low iron. Breast feeding has small amounts of iron and by itself does not provide enough iron. This can be a problem if the infant is exclusively breast fed and has used all iron stores. All formulas are iron fortified. The best source of iron is red meat. Leafy green vegetables contain iron but this is poorly absorbed.

Which groups are at risk for iron Deficiency?

  1. Preterm, or very small neonates tend to not have adequate iron stores.
  2. Breast fed infants who’s Mother’s are low in iron, particularly vegetarians.
  3. Breast fed Infants older than 6 months who are not receiving iron fortified foods.
  4. Toddlers who lack iron in their diet and consume large amounts of milk. More than 500mls per day is considered too much. Cow’s milk in large amounts means toddlers do not consume other important foods, and in some instances there is a loss of iron in the gut due to the protein irritating the intestines.
  5. Children with chronic diseases, especially involving the gut. Coeliac disease, inflammatory bowel disease and any illness that affects diet and absorption can result in iron deficiency.

If you feel you infant or toddler is at risk then organise for a blood test.

What are the symptoms of iron deficiency ?IMG_4076_Fotor_Fotor

Iron deficiency is impossible to detect unless there is moderate to severe anaemia. At this stage the toddler will be irritable, have poor appetite, appear pale and lethargic. The best place to assess for pallor is the eyelid conjunctiva. In some cases the desire to eat non food items, such as dirt, sand, clay and also ice is a clue.

How is iron deficiency assessed  ?

Assessing for iron deficiency involves a blood test which can detect iron levels and also if anaemia is present. The most important tests are a full blood count or FBC and a serum ferritin. The FBC measures the haemoglobin and number and health of the red cells and the ferrite reflects the bodies iron stores.

How do you treat iron deficiency ?Conjunctival-pallor1_Fotor_Fotor

  1. Assess for causes. The most common is nutritional, but consider other illnesses such as coeliac disease. If the toddler fails to respond to treatment further investigations are necessary.
  2. Improve diet – in toddlers limit excessive cows milk ingestion.  If this is difficult due to the demanding needs of some difficult toddlers, then switch to formula which is iron fortified.
  3. Iron supplements are required if there is anaemia.  In Australia the simplest to use is ferro-liquid. 


Weight Dosage of Ferro – liquid for iron deficiency
10kgs3mls per day
20kgs6mls per day
30kgs9mls per day
40kgs12mls per day


Adverse Affects of Iron therapyoriginal

  • GIT – Abdominal pain, nausea, vomiting, constipation, diarrhoea, black discolouration of faeces
  • temporary black discolouration of teeth (mixtures)

Gastrointestinal adverse effects may be reduced by:

  • Start at a low dose and slowly increase over 2-4 weeks
  • Giving with or soon after food (but may reduce absorption)
  • Dividing the dose into 2-3 smaller doses
  • Consider using tablets in older children
  • Use with straw to prevent teeth discolouration.

How do you prevent iron deficiency ?milk-5_Fotor

Infants – less than 12 months

  • Breast fed infants – ensure maternal levels of iron are regularly checked
  • Early introduction of red meat between 4-6 months is recommended.
  • Commercial infant cereals are also iron fortified

Toddlers – 12months to 3years

  • Limit cows milk to less than 500mls per day
  • If this is not possible then revert to formula
  • Ensure red meat is part of the diet.
  • If concerned the only way of assessing is a formal blood test.
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