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Every red blood cell in the body contains iron in its hemoglobin, the pigment that carries oxygen to the tissues from the lungs. But a lack of iron in the blood can lead to iron-deficiency anemia, which is a very common nutritional deficiency in children.
Causes of IDA
Iron-deficiency anemia can be the consequence of several factors, including:
insufficient iron in the diet poor absorption of iron by the body ongoing blood loss, most commonly from menstruation or from gradual blood loss in the intestinal tract periods of rapid growth
A diet low in iron is most often behind IDA in infants, toddlers, and teens. Kids who don't eat enough or who eat foods that are poor sources of iron are at risk for developing the condition. Poverty is a contributing factor to IDA because families living at or below the poverty level may not be getting enough iron-rich foods. Iron deficiency can also cause the body to absorb more lead, which increases the risk of lead poisoning in kids, especially those living in older homes. The combination of IDA and lead poisoning can make kids very ill and can put them at risk for learning and behavioral problems. During infancy and adolescence, the body demands more iron. Kids are at higher risk for IDA through these periods of rapid growth because they may not be getting enough iron in their diet to make up for the increased needs. In infants, discontinuing iron-fortified formula and introducing cow's milk before 12 months can lead to IDA. Cow's milk is low in the iron necessary for infant growth and development and it often replaces the consumption of iron-rich foods. Milk decreases the absorption of iron and can also irritate the lining of the intestine, causing small amounts of bleeding. This slow, gradual loss of blood in the stool combined with low iron intake may eventually result in iron deficiency and anemia.
During the first stages of puberty, when a lot of growth occurs, boys are at risk of iron deficiency anemia. But adolescent girls are at higher risk than boys for IDA because of smaller iron stores and the iron lost in the blood in their monthly menstrual flow. Many girls also tend to consume a diet low in iron.
Symptoms
Many kids with iron deficiency don't show any symptoms because the body's iron stores are depleted slowly. As the anemia progresses, you may recognize some of the following symptoms in your child:
fatigue and weakness pale skin and mucous membranes rapid heartbeat or a new heart murmur (detected in an exam by your child's doctor) irritability decreased appetite dizziness or a feeling of being lightheaded
Rarely, a person with IDA may experience pica, a craving to eat nonfood items such as paint chips, chalk, or dirt. Pica may be caused by a lack of iron in the diet.
Diagnosis
Iron-deficiency anemia is often first noticed during a routine exam. Because IDA symptoms, such as fatigue and decreased appetite, are common to many conditions, the doctor will need more information to make a diagnosis. If IDA is suspected, the doctor will probably ask questions about your family's diet. To diagnose iron deficiency, one of these blood tests will probably be done:
A complete blood count (CBC) may reveal low hemoglobin levels and low hematocrit (the percentage of the blood made up of RBCs). The CBC also gives information about the size of the RBCs; those with low hemoglobin tend to be smaller and each cell contains less hemoglobin. The reticulocyte count measures how fast these immature RBCs are produced. In IDA, they're made too slowly in the bone marrow to reach a normal level. Serum iron directly measures the amount of iron in the blood, but may not accurately reflect how much iron is concentrated in the body's cells. Serum ferritin reflects total body iron stores. It's one of the earliest indicators of depleted iron levels, especially when used in conjunction with other tests, such as a CBC.
The doctor may also do a stool test because IDA can be caused by gradual loss of small amounts of blood through the gastrointestinal tract. Since the blood may not be visible, a stool sample is placed on a special paper card and a drop of testing solution is applied. A color change indicates the presence of blood.
several more months. Once corrected, iron stores can be maintained with an iron-rich diet. About 6 months after discontinuing iron therapy, the doctor may want to recheck your child's hemoglobin. Rarely, IDA is so severe and possibly life-threatening that hospitalization and a blood transfusion may be required.
Infants younger than 1 year old should drink only breast milk or an infant formula supplemented with iron. It is important for breastfed infants to receive iron-fortified solid foods starting at about 6 months of age. Kids under 2 years old should have no more than 24 ounces of cow's milk a day. As noted earlier, milk can inhibit absorption of iron, and drinking too much milk can dampen a child's appetite for other iron-rich foods. In addition, too much cow's milk has been shown to irritate the gastrointestinal tract, which may cause intestinal bleeding a cause of iron loss. Iron-fortified products such as cereal can be a great way to get kids especially those under 2 years old to get more iron. A variety of foods can provide great sources of iron: lean meats; egg yolks; broccoli, spinach, and other green leafy vegetables; dried peas and beans; blackstrap molasses; raisins; and whole-grain bread. Make sure kids or teens on a vegetarian diet get enough iron. Because iron from meat sources is more easily absorbed than iron from plant sources, you may need to add iron-fortified foods to their diet.
Proper nutrition, which includes a diet rich in iron, is important for all kids. Establishing good eating habits early in life will help to prevent iron deficiency and iron-deficiency anemia.