Iron deficiency anaemia is not uncommon in toddlers and young children and iron is one of the few minerals than can be relatively lacking in their diet. In most cases this is due to lack of healthy eating awareness and of foods rich in iron and the nutrients that both aid and reduce its absorption. Iron deficiency is the worlds most common form of malnutrition, affecting 43% of children worldwide; in the UK it affects around 5% of toddlers and 7% of teenage girls. Iron absorption is limited to around from 15-20% in a normal diet, due to its potential toxic effects. Iron overload can happen over time with excessive supplementation and can be fatal.
An essential mineral
Iron is an essential mineral for the formation of red blood and muscle cells, which transport oxygen in the body. It is also essential for nerve cells in the brain and for immunity against infection. Toddlers have high requirements for iron due to growth of muscle and blood, and are vulnerable to deficiency if born before term or weaned late to solids. Term babies should have sufficient iron stores to last throughout the first 6 months of life, and milk feeding is sufficient until this time.
What are the symptoms?
Iron Deficiency Anaemia occurs when the haemoglobin level in red blood cells drops due to poor iron availability from stores in the body. Serum ferritin (a transport protein) reflects this iron storage and a low level is an indicator of iron deficiency anaemia. Symptoms include pallor, tiredness, reduced exercise tolerance and poor appetite and can be associated with undiagnosed gastrointestinal problems such as coeliac disease and gastro-oesophageal reflux or prolonged feeding problems such as food refusal and growth faltering.
Getting enough iron
Iron-containing foods eg. red meat, lentils & pulses, egg yolk, nut butters, fortified breakfast cereals, green vegetables, apricots should be introduced as part of weaning to solids to help infants accept the new tastes and textures. This helps ensure that they are familiar with these foods before they start to become wary of new foods around 1 year of age. They will then be more likely to eat them during their toddler years when requirements for iron are high and they derive more iron from foods than from milk feeding. The amount of iron absorbed when a food is eaten varies depending on bioavailability. See post to maximise your iron intake for more information.
Does my child need a supplement?
There are a variety of supplements containing iron available in chemists and supermarkets, often as part of a multi-vitamin/minerals supplement. Those containing iron values around 100% of the recommended intake (RI) are suitable for short periods eg. 3 months, as a tonic. Iron supplementation of larger amounts should only be given under dietetic or medical supervision, as iron overload can be dangerous and in extreme situations fatal.
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