Dear DR. PAUL: My 18 month old son recently had his blood drawn to check his iron count and it came back very low. What exactly does iron deficiency do for children as far as intelligence and development?
PEDIATRICIAN DR. PAUL Answers: Thanks for the very timely question as there have been several recent reports on the effect of iron deficiency anemia on both developing infants and older children too. Before I go on further let me explain what iron deficiency anemia means. Ordinarily, our red blood cells contain a substance called hemoglobin. Iron is a key ingredient in forming hemoglobin. If there is not enough iron in the body, then an insufficient or lower amount of red blood cells are produced. This is referred to as “iron deficiency anemia”.
Up until about 20 years ago we thought that the only consequences of iron deficiency were limited to physical symptoms such as pale complexion and fatigue. During the early 1990’s the medical community became concerned when studies suggested that iron deficiency anemia was linked to developmental delays. This effect was confirmed by a more recent study. At about the same time, other studies revealed a surprisingly high incidence of iron deficiency anemia in babies/toddlers. Alarmingly, the developmental delays in some severe cases, did not improve despite treatment with iron. Clearly then, we must prevent iron deficiency anemia in the first place by ensuring children eat enough iron-containing foods. Babies are born with enough iron in their bodies for the first 4 to 6 months of life. After that period, extra iron in the diet is required.
One of the factors that is thought to contribute to anemia is the early introduction of whole cow’s milk in the diet; This is why the Canadian Pediatric Society currently recommends avoiding whole cow’s milk for most of the first year of life. (The American Academy of Pediartics recommends avoiding whole cow’s milk for the first 12 months of life)
In order to be able to use dietary iron, it must be able to be absorbed into the body. For example, whole cow’s milk contains as much iron per liter as breast milk, but only a very small proportion is actually absorbed into the body. However, the iron in breast milk, is very well absorbed by babies. For this reason, breast milk is one of the best sources of iron for baby providing all the iron needed(along with all other nutrients and benefits) for the first 6 months of life. Bottom line: breastfeeding is the best way to prevent iron deficiency anemia in babies. If breastfeeding is not an option, or is stopped before 9-12 months, then iron-fortified formulas, which contain added iron, should be given to baby instead of whole cow’s milk.
A recent study suggested that iron deficiency anemia in pre-teens was associated with poor math scores. Although this is one study, looking at it in the context that iron deficiency has been linked to developmental/intellectual delays, it makes sense to ensure adequate iron intake in the diet through-out childhood and adolescence. Dietary sources of iron include red meat, liver, green leafy vegetables, fruits, legumes and iron fortified cereals and breads.
On a final note, if supplemental iron drops or tablets are ever prescribed, these should only be given as directed by a doctor and be stored out of the reach of children, as accidental iron over-dosage can be quite dangerous.
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