Iron Supplementation In Babies and Children
What Is Iron?
Iron is a mineral. It is an important part of every cell in the human body. Most importantly, iron is found in the red blood cells where it helps deliver oxygen to all of the organs and tissues.
What Happens When the Body Has Low Iron?
Iron is needed to create new blood cells. A lack of iron can cause a low blood count called anemia. Anemia is one of the most common nutritional problems worldwide.
Anemia can lead to a number of problems, including:
- Decreased energy
- Pale skin color
- Problems with concentration
- Shortness of breath
- Cold feet and hands
- Chest pain and rapid heartbeat
Babies and young children need iron for proper growth and development of their entire bodies, in particular their rapidly growing brains. When young children are anemic, they may show delays in normal development. They may have problems in school, including difficulty completing tasks and problems paying attention. Remember, however, that not all children with anemia have the symptoms listed above. Also, some children have low iron levels but have not yet developed anemia.
Are Some Children at Higher Risk for Anemia?
Some children are more likely to become anemic. Children who are born prematurely, have a low birth weight, live in poverty, or are recent immigrants have a higher risk of developing anemia. Adolescent girls are at higher risk of anemia due to blood loss from their menstrual periods.
How Can I Make Sure My Child Is Getting Enough Iron?
Generally, full-term breastfed babies are thought to receive enough iron in breast milk for the first 4 months of life. After that, they will need to be given an iron supplement until they get enough iron from other sources, such as iron-fortified formula or iron-rich food. Formula-fed infants need iron-fortified formula. After babies are taking solid foods, they should be getting iron-rich food, such as meat or iron-fortified cereal, each day. Premature babies should almost always be given extra iron starting at 1 month of age to 12 months, either as supplements, if eating breast milk, or special supplemented formula.
Children under 12 months old should not drink cows milk. Because cow’s milk is a poor source of iron, toddlers are prone to developing anemia if they drink more than 2-3 cups of milk each day. If you restrict how much cow's milk your child drinks, they will be more likely to eat foods that are higher in iron.
Your child should have a balanced diet that includes daily portions of iron-rich foods, such as:
- Liver, beef, poultry, pork, lamb
- Tuna, salmon
- Iron-fortified cereals and breads
- Dried beans such as limas, soybeans, pinto and kidney beans, split peas, black-eyed peas
- Whole grains, including wheat, millet, oats, and brown rice
- Dried fruits such as apricots, raisins, prunes, dates, peaches
- Dark green vegetables, including leafy greens like spinach, kale, and collards, as well as broccoli and asparagus
- Blackstrap molasses
Interestingly, the body absorbs iron from animal sources such as meats better than iron from plant sources. Ascorbic acid (vitamin C) also helps the intestine absorb iron more efficiently. Serve iron-rich foods with drinks or foods that are high in vitamin C. Examples include: orange juice, citrus fruits, broccoli, strawberries, and melon.
Should My Child Be Tested for Anemia?
Anemia can be easily detected with a simple blood test. Different organizations have different recommendations regarding routine screening for anemia. Often children are checked for the first time at about 1 year of age. If your child is at higher risk, it may be done earlier. Let your child's doctor know if you are concerned that your child has anemia or is at risk for anemia.
How Much Iron Does My Child Need?
The exact amount of iron needed in the diets of children varies depending on age and gender. For example, because teen girls lose iron through menstrual blood, they need more iron than teen boys. Here are some basics on how much iron children need per day at various ages:
Age of Child
|7-12 months||11 mg||11 mg|
|1-3 years||7 mg||7 mg|
|4-8 years||10 mg||10 mg|
|9-13 years||8 mg||8 mg|
|14-18 years||15 mg||11 mg|
What Should I Do if My Child Is Anemic?
If your child is anemic, talk to the doctor to make sure that your child is eating a well-balanced diet that is rich in iron-containing foods.
If the doctor thinks that your child needs to take iron supplements, you should ask which form of iron your child should take. There are many types on the market, and you may need to try several to find one that your child tolerates. The doctor may encourage you to give your child a food or beverage containing vitamin C along with the iron supplement to improve its absorption. If your child has any stomach upset from the supplement, you may be asked to give smaller doses several times a day.
If you are giving your child iron supplements, carefully follow the doctor's instructions. Iron at doses that are higher than the ones listed in the table above can cause symptoms in children. Never give more than the amount prescribed, even if you have accidentally missed a dose.
How Can I Safely Store My Child’s Iron Supplements?
Iron supplements are a leading cause of poisoning deaths in young children. Even though our bodies need a certain amount of iron, excess iron can cause serios problems and even kill—especially when small children swallow iron supplements intended for use by adults. To keep your child safe, put the supplements on the highest shelf of your cabinet, preferably in a locked cupboard. The supplement should also be in a marked container with a child-resistant lid.
If you think that your child may have taken an overdose of iron supplements or other multivitamins that contain iron, immediately contact the Poison Control Center, the doctor, or the nearest hospital’s emergency department.
Healthy Children—American Academy of Pediatrics
United States Department of Agriculture
About Kids Health—The Hospital for Sick Children
Anemia—differential diagnosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated October 23, 2015. Accessed January 6, 2016.
Chantry CJ, Howard CR, Auinger P. Full breastfeeding duration and risk for iron deficiency in U.S. infants. Breastfeed. 2007;2(2):63-73.
Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics. 2010 November 1;126(5):1040-1050. Available at: http://pediatrics.aappublications.org/content/early/2010/10/05/peds.2010-2576.abstract. Accessed January 6, 2016.
Human nutrition: iron. Ohio State University website. Available at: http://ohioline.osu.edu/hyg-fact/5000/5559.html. Accessed January 6, 2015.
Iron. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/academic/natural-alternative-treatments. Updated August 2013. Accessed January 6, 2016.
Iron. Office of Dietary Supplements website. Available at: http://ods.od.nih.gov/factsheets/Iron-HealthProfessional/. Updated November 24, 2015. Accessed January 6, 2016.
Recommendations to prevent and control iron deficiency in the United States. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/mmwr/pdf/rr/rr4703.pdf. Published April 3, 1998. Accessed January 6, 2016.
Screening tests for infants. Lab Tests Online website. Available at: http://labtestsonline.org/understanding/wellness/ab-infant-1/ab-infant-2/. Updated December 22, 2015. Accessed January 6, 2016.
What are the signs and symptoms of iron-deficiency anemia? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/ida/signs.html. Updated March 26, 2014. Accessed January 6, 2016.
10/12/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Baker R, Greer F, the Committee on Nutrition. Clinical report—diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). American Academy of Pediatrics website. Available at: http://pediatrics.aappublications.org/cgi/reprint/peds.2010-2576v1. Published October 5, 2010. Accessed January 6, 2016.
Last reviewed January 2016 by Michael Woods, MD Last Updated: 1/30/2014