Iron
deficiency is still a big problem today. In fact, the World
Health Organization lists iron deficiency as one of the
'Top Ten Risk Factors Contributing to Death'.
Other
facts about iron deficiency:
- As
many as 4-5 billion people, 66-80% of the world’s
population, may be iron deficient
- 2
billion people – over 30% of the world’s population
– are anemic, mainly due to iron deficiency
- In
total, 800,000 (1.5 percent) of deaths worldwide are
attributable to iron deficiency
Surprisingly,
iron deficiency anemia is not just a problem in developing
countries of the world. According to the CDC, 'although
iron deficiency is more common in developing countries,
a significant prevalence was observed in the United States
during the early 1990s among certain populations, such
as toddlers and females of childbearing age.'
In
one study, 7% of toddlers aged 1-2 years and 9-16% of
adolescent and adult females aged 12-49 years were found
to have iron deficiency.
Also
at risk are premature babies who are born with low stores
of iron in their bodies.
Although
the incidence of childhood iron-deficiency in the United
States has been decreasing and iron deficiency anemia
is uncommon, we are still above the Healthy People 2010
objectives of 5%, 1%, and 7% for toddlers, preschool children,
and females aged 12--49 years, respectively.
Why
is battling iron deficiency important?
Because
'iron deficiency anemia significantly impairs mental and
psychomotor development in infants and children,' leading
to developmental delays and behavioral disturbances. It
can also increase the risk for a preterm delivery and
delivering a low-birthweight baby in pregnant women who
are iron deficienct.
Prevention
of Iron Deficiency
in Infants and Toddlers
It
can help to understand how to prevent iron deficiency
if you understand how the body stores iron. Babies, unless
they are born premature, are born with all of the iron
they need for the first 5-6 months of life. After that,
unless they are given an iron supplement, they can develop
iron deficiency, which means that they don't have enough
iron in their body. If it continues, it will then lead
to iron deficiency anemia.
So
to prevent iron deficiency, you should breastfeed or give
your infant an iron fortified infant formula (avoiding
low iron formula) until they are at least 12 months of
age, and begin an iron supplement by about 6 months of
age.
Starting
an iron supplement doesn't necessarily mean starting them
on a vitamin with iron though. The usual supplement is
simply an iron fortified infant cereal given once or twice
a day. Remember that preemies or low birth weight infants
do usually also need a vitamin with iron.
After
you have introduced an iron fortified infant cereal, start
one feeding a day of foods rich in vitamin C (e.g., fruits,
vegetables, or juice) to improve iron absorption, preferably
with meals.
Causes
of Iron Deficiency
It
is now easy to see why some infants develop iron deficiency,
which is usually because they aren't getting enough
iron. However, other causes or iron deficinecy can include
blood loss and impaired absorption of iron, although
that is rare.
Most
kids become iron deficient because they aren't getting:
- breastmilk
or an iron fortified infant formula until 12 months
- an
iron supplement after 6 months
- a
vitamin with iron if they were born premature or low
birth weight
or
if they are getting cow's milk or goat's milk before
12 months, instead of breastmilk or formula.
Unlike
breastmilk and iron fortified formula, cow's milk and
goat's milk have minimal amounts of iron in them and
they are poorly absorbed. Cow's milk may also cause
younger infants to have some gastrointestinal bleeding,
which makes it even more likely that they will develop
iron deficiency anemia.
Toddlers
who drink more than 16-24 ounces of milk are also at
risk for developing iron deficiency. In addition to
not having much iron in it, cow's milk decreases how
well your body absorbes iron from other foods. And toddlers
who are drinking a lot of milk are likely getting filled
up and probably aren't eating a lot of foods with iron
in it anyway.
Because
preschool and younger school age children are not going
through periods of rapid growth and they have lower
ron requirements, they are not at big risk of iron deficiency.
The
risk does go up again during the teens years, because
they are growing rapidly and have increased iron requirements.
Girls who have started their periods, especially if
they have heavy menstrual blood loss, are also at increased
risk of iron deficiency.
Prevention
of Iron Deficiency in Teens
To
prevent iron deficiency in teens, they should be encouraged
to eat iron-rich foods and foods that enhance iron
absorption. Those who are at risk of becoming iron
deficient should be tested and given an iron supplement
if they do have iron deficiency.
Screening
for Iron Deficiency
The
CDC recommends that children who are at high risk
for iron-deficiency anemia should be tested for anemia
between ages 9 and 12 months, 6 months later, and
annually from ages 2 to 5 years.
It
is also recommended that, starting in adolescence,
you should screen all nonpregnant women for anemia
every 5-10 years throughout their childbearing years
during routine health examinations, annually for women
having risk factors for iron deficiency, and at the
first prenatal care visit if they are pregnant.
The
American Academy of Pediatrics recommends screening
by 9 months of age and again between ages 11 and 21
years for all menstruating teens.
No
routine screening for iron deficiency is recommended
for teen boys.
Treatment
of Iron Deficiency
In
addition to improving the child's diet, treatment
of iron deficiency involves giving the child an iron
vitamin. For infants and younger children, this usually
means prescribing 3 mg/kg per day of iron drops to
be administered between meals divided once or twice
a day.
Adolescent
girls and women who have anemia are usually prescribed
an oral dose of 60-120 mg/day of iron.
Foods
that are Good Sources of Iron
- Meats
-- beef, pork, lamb, and liver and other organ meats
- Poultry
-- chicken, duck, and turkey, especially dark meat;
liver
- Fish
-- shellfish, like clams, mussels, and oysters;
sardines; anchovies; and other fish
- Leafy
greens of the cabbage family, such as broccoli,
kale, turnip greens, collards
- Legumes,
such as lima beans and green peas; dry beans and
peas, such as pinto beans, black-eyed peas, and
canned baked beans
- Yeast-leavened
whole-wheat bread and rolls
- Iron-enriched
white bread, pasta, rice, and cereals. Read the
labels.
