Studies continue to show that iron deficiency in infancy and early childhood is associated with negative neurocognitive, motor and behavioural effects, some of which persist despite treatment.  

THE MAINSTAY OF treatment remains oral iron.  Iron-deficiency anaemia can be caused by:  

• Diets low in iron. A child gets iron from the food in his or her diet. But only a small amount of the iron in food is absorbed by the body
  • Full-term newborns, born to healthy mothers, have iron that they get during the last three months of pregnancy 
  • Infants of mothers with anaemia or other health problems may not have enough iron stored. And infants born early may not get enough iron
  • At 4-6 months of age, the iron stored during pregnancy is at a low level. And more iron is used as the infant grows
  • The American Academy of Pediatrics (AAP) advises feeding the infant only breastmilk for the first six months. But breastmilk does not have a lot of iron, so infants that are breastfed only, may not have enough iron
  • Older infants and toddlers may not get enough iron from their diets 

• Body changes. When the body goes through a growth spurt, it needs more iron for making more red blood cells
• Gastrointestinal tract problems. 
  Poor absorption of iron is common after some forms of gastrointestinal surgeries.
  When you eat foods containing iron, most of the iron is absorbed in the upper small intestine. Any abnormalities
  in the gastrointestinal (GI) tract could alter iron absorption and cause iron-deficiency anaemia  
• Blood loss. Loss of blood can cause a decrease of iron. Sources of blood loss may include gastrointestinal bleeding, menstrual bleeding, or injury. 

HOW IS IRON-DEFICIENCY ANAEMIA DIAGNOSED IN A CHILD?  

In most cases, anaemia is diagnosed with simple blood tests. Routine anaemia screening is done because anaemia is common in children, and they often have no symptoms.  

• The AAP recommends anaemia screening with a haemoglobin blood test for all infants at 12 months of age. The screening should also include a risk assessment. This is a group of questions to find risk factors for iron-deficiency anaemia. Risk factors include feeding problems, poor growth, and special healthcare needs. 
• If the haemoglobin level is low, more blood tests are done 
• If the child has a risk factor at any age, blood tests are done 
• Blood tests for anaemia may also be done during routine physical exam or check-ups in children of any age. 

   Treating iron-deficiency anaemia includes:  

• Iron supplements. Iron drops or pills are taken over several months to increase iron levels in the blood. Iron supplements can irritate the stomach and discoloured bowel movements. They should be taken on an empty stomach or with orange juice to increase absorption. They are much more effective than dietary changes alone. If the child can’t take drops or pills, IV iron may be needed, but this is very unusual
• Iron-rich diet. Eating a diet with iron-rich foods can help treat iron-deficiency anaemia. 

  Source: SAMJ, University of Rochester Medical Centre