In 2016, Jahnavi, a young mom from Singapore, noticed that her eight-month-old son’s skin started turning pale and he was cranky most of the time. Following the pediatrician’s advice, a complete blood test was conducted, revealing that the baby had iron deficiency. His hemoglobin level was around 9 g/dl, compared to the normal range of 9.5–13 g/dl in infants. He was put on supplements to address the issue. Iron deficiency, a common nutritional issue in children and adolescents, can make them susceptible to iron deficiency anemia if left untreated, say experts.
Prolonged iron deficiency can lead to anemia
Iron is an essential element involved in the production of hemoglobin — a protein present in the red blood cells that transports oxygen and removes carbon dioxide from the body. Prolonged iron deficiency can lead to iron deficiency anemia, says Dr Rashi Aryan, pediatrician, Dr L H Hiranandani Hospital, Mumbai. “Iron deficiency occurs when the total iron in the body decreases. However, reduction of the mineral to alarmingly low levels hinders the adequate production of red blood cells, giving rise to iron deficiency anemia,” she explains.
Iron deficiency anemia can occur at any age, with children (between the ages of six months and two years) and adolescents being at higher risk of developing the condition, she points out. As per the Comprehensive National Nutrition Survey (CNNS) conducted in 2019, adolescent girls (between the ages of 11 and 19) are at higher risk of developing the condition compared to boys of the same age group.
Causes of iron deficiency in children
“Children between six and nine months are in the transition phase, wherein the fetal hemoglobin (the major hemoglobin present in the fetus during gestation) gets converted to adult hemoglobin in the body,” explains Dr Ramu DS, senior consultant and pediatric intensivist, BGS Gleneagles Global Hospital, Bangalore. Insufficient iron intake during this period may increase the risk of deficiency in some of them, he adds.
“Overconsumption of milk — be it cow, buffalo or formula milk — during the weaning period, accompanied by nutritional insufficiencies, increases the risk of iron deficiency in children,” points out Dr Aryan.
In teens, iron deficiency is largely caused by unhealthy eating habits, sudden growth spurts and the onset of the menstrual cycle (in girls). The CNNS revealed that only two out of 10 adolescents rarely consumed green leafy vegetables — a rich source of iron.
Worm infections can also contribute to iron deficiency in children, which can result from eating unhygienic foods or drinking contaminated water, says Dr Aryan.
Signs and symptoms of iron deficiency
Pale skin and irritability are some prominent signs of iron deficiency in children, shares Dr Ramu. “The paleness is particularly evident under the eyelids, lips, tongue and palms, wherein the skin turns white,” says Dr Aryan. “Other signs include fatigue, temper tantrums, excessive holding of breath, pica or eating non-edible things such as chalk, mud and brick pieces.”
Severe cases of iron deficiency will significantly lower hemoglobin levels, reducing the number of red blood cells in the body. “This can increase the risk of shortness of breath in children,” says Dr Ramu.
Iron deficiency also increases the risk of neurological issues, such as seizures. If left untreated, it can increase the risk of malnutrition, growth retardation and weakened immunity.
Diagnosing iron deficiency in children
Experts recommend a battery of tests to diagnose iron deficiency in children. A complete blood count is a common test for assessing iron levels. However, Dr Ramu suggests iron profile tests to detect the condition, which include the analysis of serum ferritin, serum transferrin and the total iron binding capacity (TIBC).
Treatment
It generally takes three months to build iron in the blood. Mild to moderate cases of iron deficiency can be treated with supplements and iron-rich foods. “Iron levels can be re-evaluated in children after a month of medication and an iron-rich diet,” says Dr Aryan. Severe cases of iron deficiency (where hemoglobin levels drop below 9 g/dl) require blood transfusions to prevent the risk of cardiac failure, informs Dr Ramu.
For Jahnavi’s son, iron and vitamin supplements accompanied by an iron-rich diet for two months helped normalize his iron levels.
Preventing iron deficiency: Diet plays a key role
Diet plays a key role in preventing iron deficiency, says Dr Aryan. Beetroot, pomegranate and ragi porridge can help maintain optimal iron levels in children, she adds, advising against excessive consumption of milk.
“Green leafy vegetables, especially moringa leaves, are highly beneficial. Additionally, coriander leaves, spinach and dill leaves are also rich in iron,” shares Dr Ramu.
Since 2016, Jahnavi has made sure to incorporate ragi, spinach, beetroot, pomegranate and gooseberries into her son’s diet; she cooks in cast iron vessels as well. Further, she adds a dash of lemon juice to his food, as vitamin C helps with the easy absorption of iron. “I’ve also replaced white sugar with jaggery in fresh fruit juices and smoothies, as it’s rich in iron,” shares Jahnavi. “In addition, deworming every six months has also helped maintain healthy iron levels in my son.”
Takeaways
- Iron deficiency is a common nutritional issue in children that can lead to iron deficiency anemia if left untreated. Toddlers and adolescents are more likely to develop this condition.
- Iron deficiency can occur due to unhealthy eating habits, sudden growth spurts, worm infections and the onset of the menstrual cycle (in girls).
- The symptoms of iron deficiency include pale skin, fatigue, temper tantrums, excessive holding of breath and pica.
- An iron-rich diet and supplements (taken under medical supervision) can address iron deficiency in children. In addition, deworming at regular intervals can also help.
