Anemia in teens and children can creep up unexpectedly, causing your once energetic bundle of joy to become moody, lethargic, and severely unwell. In the US, it’s estimated that 20% of children will be diagnosed with anemia at some point in their childhood or adolescence. What begins as a mild iron deficiency can escalate to iron deficiency anemia (IDA) if left untreated.

When your child becomes anemic, they no longer have enough healthy red blood cells to carry oxygen around their developing body. Therefore, they will become tired and lethargic. Iron is critical for optimal brain functioning. Iron deficiency can lead to mental fogginess as well as hinder your child’s growth and development.

Who is at risk of iron deficiency?

Certain factors increase the likelihood of a child developing iron deficiency, particularly as they grow and enter new life phases. In the early years, babies born prematurely, with low birth weight, or who drink cow’s milk before age 1 are more likely to become iron deficient.

Breastfed babies who aren’t given iron-rich complementary foods at around 6 months of age and babies who drink formula that isn’t fortified with iron are also more susceptible. IDA is most commonly a result of a lack of consumption of iron-rich foods in the diet, malabsorption of the iron-rich foods consumed, an increase in blood loss, or insufficient consumption during periods of growth when the requirements naturally increase. For instance, as teen girls mature, they require higher amounts of iron to replace blood losses during menstruation.

Additionally, iron deficiency risk increases in children with certain health conditions, restricted diets, chronic illness or infections, exposure to lead, overweight and obese, or those who don’t eat enough iron-rich foods. For example, while dark leafy green veggies are a good source of iron, dietary iron from meat is better absorbed by the body than iron-rich veggies. Hence children following a vegetarian lifestyle are at greater risk of iron deficiency.

Malabsorption conditions such as celiac disease can also be accompanied by iron deficiency. Infection with helicobacter pylori, a common infection found in children, can impair dietary iron absorption and increase iron loss.

In other instances, your child may suffer from severe anemia due to significant blood loss, dysfunction in red blood cell production, or medical conditions that may destroy red blood cells. These conditions are mainly associated with a family history of inherited hematological disorders or disorders from malabsorption.

Symptoms of anemia in children

Many children may be suffering from mild anemia before ever showing any symptoms. When the first symptoms present themselves, it is most commonly noticed as increased tiredness, weakness, or increased susceptibility to infections.

As the anemia progresses, symptoms may become worse and include:

• Paleness of the skin
• A lighter shade of pink on the lining of eyelids, gums, and nail beds
• Headache, irritability, or dizziness
• Cognitive dysfunction
• Pica, which is often associated with pregnant women. Your child may eat odd non-food items such as ice, dirt, clay, paper, or cardboard and may become constipated.

Severe iron deficiency anemia symptoms include:

• Febrile convulsions in kids who are under 5 years old
• Difficult or rapid breathing and/or a fast heartbeat
• Yellow skin, yellow eyes, or dark tea/cola-colored urine caused by jaundice
• Swollen hands or feet
• Restless leg syndrome, which is a resistible urge to move the legs, especially in the evenings
• Fingernail changes such as Koilonychia where the nails appear “spoon shaped”
• Inflammation or sores at the corner of the mouth or inflammation of the tongue

How much iron do kids need?

Children age 7-12 months require 11 mg of iron per day due to their rapid growth rate. From ages 1-3 years old, this drops down to 7 mg per day. At 4-8 years, they need 10 mg of iron while 9-13 year old kids should take 8 mg per day.

In adolescence, the recommended dietary allowance (RDA) varies between boys and girls. Adolescent boys require 12 mg a day, while adolescent girls need 15mg a day due to menstruation blood loss. Teens may also require a little more if they are highly athletic.

Increasing iron in children’s diet

Naturally, our bodies can only absorb 5% of dietary iron found in plant products and vegetables and up to 20% of the iron found in meat products. Iron-rich foods include dark green leafy vegetables, meats, apricots, prunes, raisins, and iron-fortified bread. Iron can also be found in vegetarian options such as soy products like tofu, soy milk, as well as chickpeas, lentils, and white beans.

Does milk have iron? Milk and its substitutes are poor sources of iron. If anything, milk interferes with your body’s ability to absorb iron from food and supplements. You can increase the amount of dietary iron absorption by combining leafy vegetables with meats or consuming vitamin C.

It helps to implement a few changes in your child’s diet to help them get healthy amounts of iron:

• Buy fortified breakfast cereals and bread that have added iron in them.
• Mealtimes with iron-rich diet should include a serving of fruit or veggies rich in vitamin C to aid the absorption of iron.
• For young children, daily food intake with iron included might look like baked beans on fortified toast with a glass of orange juice. You can offer 2 scrambled eggs with spinach or tomatoes or a chicken breast and bell peppers in a fortified tortilla wrap during lunchtime. Dinner often has these combinations when you think of spaghetti bolognese, which combines both beef and tomato sauce.
• As your child gets older, their portions will naturally increase. If a healthy food balance is maintained, their iron intake will also naturally increase.
• Some dietary substances can hinder the absorption of dietary iron by as much as 50%. They include tannins from tea, phytates from bran products, as well as calcium from milk products. Your children should have tea and milk only at snack and meal times.
• According to the American Academy of Pediatrics, breastfed only infants should be given a daily iron supplement iron from 4 months of age until they begin eating iron-rich foods. Formula-fed infants don’t need iron supplements since formula has iron added to it.
• Don’t give whole milk to infants less than 12 months old. Give not more than 3 glasses (8 oz. or 250 ml) of cow milk per day to children age 1-5 years because excessively consuming cow’s milk can also contribute to iron deficiency.
• Some medications such as tetracyclines, quinolones, antacids, and proton pump inhibitors can hinder iron absorption. So if possible, avoid such drug-food interactions.

Conclusion

If you have any concerns about whether your child is suffering from anemia, a quick trip to the doctor can alleviate these fears. Catching anemia early on allows for a simple diet change to relieve symptoms and get your child back on track. More severe cases of anemia may require dietary supplements or other medical interventions. It is important to remember that many children with anemia may not show obvious symptoms, so have their iron levels checked regularly.