Paediatric and Teenage Nutrition

food, feeding and nutrition

Tag: iron deficiency anaemia

Iron Deficiency Anaemia in infancy

Iron deficiency anaemia (IDA) is the most common nutritional problem affecting infants with 60% of 6-12 month old babies in the UK having low dietary iron intake, a key risk factor for developing IDA. Early childhood is a time of vulnerability as iron deficiency anaemia in this period is associated with brain development.   It’s a time of rapid physical growth, and a time when dietary iron needs are at their highest. Various risk factors are known to contribute to IDA: particularly premature birth, very low birth weight and maternal iron deficiency.  Infant feeding practices including the introduction of solids are important considerations.  Iron absorption is limited (by the gut) to around 15-20% and this becomes relevant when thinking about choosing iron-rich foods to offer. Iron contained within plant and animal foods differ, with absorption being higher from animal foods, which can be improved in the presence of Vitamin C. Here I provide some information about nutritional needs, dietary sources and infant feeding practices.

Infants’ Nutritional needs and Dietary sources of iron

An essential micronutrient, iron is required to make haemoglobin, the red pigment in haemoglobin, which carries oxygen around the body within the red blood cells. IDA means that the blood carries less oxygen than the body needs.  Infants with IDA will be pale and tired, have poor resistance to infection and their general health, appetite and vitality is limited.  Typically, infants don’t show any signs in the early stages of IDA, and it commonly goes undiagnosed until they become symptomatic. Iron needs are highest at 6-12 months, when term babies will have used up all their body’s stores of iron, which built up during the last trimester of pregnancy. Dietary iron needs rapidly increase then. Introducing iron-rich foods is critical at this age: to provide essential dietary iron, and to introduce and establish the familiar tastes, smells and textures of iron-rich foods.  Red meat, liver, egg yolk apricots, dried fruits, green vegetables, lentils, avocado, oily fish, seed and nut butters are all food rich in iron. The required daily intake of iron for a healthy, term baby is 7.8mg, half of that needed by a women of child bearing age.

Infant Feeding practices and the Introduction of Iron-rich foods

Breast-fed infants need iron-rich foods on a daily basis from the weaning period,  as breast milk contains very little iron. Drinking iron-fortified formula does protect against IDA, but formula-fed infants also need to become familiar with iron-rich foods to broaden their diet. Becoming familiar iron-rich foods at an early age improves acceptance and continual consumption of these foods, throughout toddlerhood.  This applies to other food too, that have been eaten regualrly during the sensitive period at 6-12 month, and infants are more familiar with those foods and have practiced eating them.  First formula milks, those with a higher ratio of whey, are best suited for all babies until 1 year for many reasons, with improved absorption of nutrients including iron; there is none for follow-on formulas, as all formulas comply with standardised contents for key nutrients.

foods rich in iron

All children need regular sources of iron-rich food, especially during later infancy, toddlerhood, teenage girls and for those following vegetarian or vegan diets.  Iron availability from food is variable, and absorption in the intestine is limited to around 15-20%.  Iron absorption depends on a number of changing factors: the iron status within the body, general health.  Iron absorption generally decreases with age. The availability of iron within food is known as bioavailability.  We depend on dietary iron to make haemoglobin, the oxygen-carrying molecule found in our red blood cells. Delivery of oxygen to the body, muscle and brain is its most important role in the body, but also for brain development, concentration and stamina. Vegan infants, children and teenage girls will need an iron supplement; but it’s also good to be aware of the natural rich sources,   foods fortified with iron and factor affecting its absorption.

Maximise iron intake, absorption and bioavailability with these top tips
  • Avoid giving milk with a meal as the high calcium content of milk reduces iron absorption
  • Do include fruits and vegetables with each meal; the Vitamin C content increases iron absorption
  • Avoid giving children tea; the tannins in tea bind iron and reduce its absorption
  • Foods containing haem-iron and from animal sources like red meat and eggs are absorbed well
  • Foods containing non-haem-iron from plant sources like cereals, fruits, nuts, pulses and vegetables are less well absorbed
  • Eating meat 1 -2 x a week, 3-6 eggs per week, regular beans, pulses, nuts, fruits, cereals and vegetables will meet the needs of most children
  • Other plant sources of iron include apricots, blackcurrants, figs, prunes, cocoa, dark green leafy vegetables, lentils, edamame beans, kidney beans, soya mince, TVP,  tofu, cashew nuts, peanuts, tahini, sesame seeds, pumpkin seeds, oats, wholegrains, quinoa, fortified cereals eg. ready brek, weetabix
    • Please note that because tofu is also rich in calcium, the absorption is limited to around 5-10%
  • Vegetarian and vegan school children generally have lower iron status but do get sufficient iron from beans, pulses, soya mince, nuts, nutritional yeast with iron, tofu, fruits, cereals and vegetables – vitamin C intake is a valuable addition to enhance absorption for this group
  • Toddlers can reduce the risk of iron deficiency by having water with main meals instead of milk