Iron Deficiency in Children - Symptoms, Causes & Treatment for Low Iron in Kids

Written by Kate Shore - 28th February, 2024

Low iron in children is a widespread issue and something I see a lot in my clinic. Sometimes, it’s the main reason parents bring their children for a consultation; other times, it’s something evident in their pathology testing or symptoms. There are many contributing reasons for it, such as low intake of iron-rich foods, a family history of low iron stores, or absorption issues. Still, it’s not always as simple as taking a supplement to boost iron levels. It’s important to consider the underlying causes so that treatment is long-lasting and doesn’t progress to iron deficiency or iron deficiency anaemia.

Low Iron In Kids

Iron deficiency is one of the most common nutritional deficiencies worldwide, affecting millions of children each year. In fact, according to the World Health Organization (WHO), 40% of children worldwide between 6 months and 5 years of age are anaemic (3). In Australia, low iron intake is a problem for many children, contributing to iron deficiency (4)

Low iron in kids is a big factor in many of the common symptoms that I see, such as hyperactivity, fatigue, lack of concentration and poor immune function. By improving iron intake and/or absorption, and replenishing iron stores, we see a big improvement in these areas.

Why Is Iron Important For Kids?

But first, why do kids need iron?

Iron is an important nutrient for children, playing a crucial role in growth and development. One of its primary functions is its role as a component of hemoglobin, the protein in red blood cells responsible for transporting oxygen around the body. Without enough iron, your child’s body can't produce enough healthy oxygen-carrying red blood cells, explaining symptoms such as fatigue, weakness, and difficulties concentrating, affecting their cognitive development and ability to thrive in activities.

Iron is also essential in immune system function. It is required for the proper growth and function of immune cells, such as lymphocytes and natural killer cells, that are important in recognising and defending the body against pathogens. This is particularly relevant for young children whose developing immune systems are constantly exposed to germs at school and childcare.

It plays a pivotal role in the synthesis of enzymes and neurotransmitters, contributing to various metabolic processes such as energy production, and DNA synthesis. In terms of brain function, it is required for neurotransmitters ike dopamine, influencing aspects such as mood regulation, motivation, and cognition.

With such far-reaching effects, iron deficiency during childhood can lead to long-term consequences such as impaired cognitive abilities, delayed physical growth, and compromised immune function, and it’s important to understand and recognise the signs of low iron in kids

Understanding Iron Deficiency

If left untreated, low iron in kids can lead to iron deficiency. Iron deficiency occurs when the body's iron stores (known as ferritin) are depleted, leading to inadequate iron levels needed for normal function. It can develop gradually over time due to low dietary intake, poor absorption, increased demand (such as during periods of rapid growth), or chronic blood loss. And when iron deficiency continues for too long, we see iron deficiency anaemia.

Stages of Iron Deficiency

Iron deficiency progresses through several stages, each with its own characteristics and implications. These stages include:

Stage 1: Depletion of Iron Stores: In this initial stage, iron stores in the body become depleted, but hemoglobin levels remain within the normal range. There may be no obvious symptoms at this stage, and it won’t always be detected without pathology tests.
Stage 2: Iron-Deficient Erythropoiesis: As iron stores continue to decline, the body's ability to produce hemoglobin becomes impaired. This stage is characterised by a decrease in haemoglobin levels , and can present with symptoms such as fatigue.
Stage 3: Iron Deficiency Anemia: In the final stage, iron deficiency progresses to iron deficiency anemia, marked by low haemoglobin levels and diminished oxygen-carrying capacity in the blood. Signs of anemia in children can include fatigue, difficulty concentrating, hyperactivity and dizziness.

How much iron does my child need?

The recommended daily intake of iron for kids varies depending on factors such as age, gender, and individual health status. In Australia, the National Health and Medical Research Council (NHMRC) provides guidelines on the recommended dietary intake (RDI) of iron for different age groups:

Daily Iron Requirement by Age

Adapted from Nutrient Reference Values for Australia and New Zealand: Iron

For infants aged 7-12 months, the RDI for iron is 11 mg per day. Breastfed infants usually obtain sufficient iron from breast milk, but it's important to introduce iron-rich foods into their diet as they begin to wean. Iron-fortified cereals, meats, and legumes are excellent sources of iron for infants.

Toddlers aged 1-3 years require 9 mg of iron per day. At this stage, children are typically transitioning to solid foods and exploring a variety of tastes and textures. Including iron-rich foods such as lean meats, poultry, fish, tofu, beans, lentils, fortified cereals, and green leafy vegetables in their diet is essential to meet their iron needs.

As children grow older, their iron requirements decrease slightly. Children aged 4-8 years need 10 mg of iron per day, while those aged 9-13 years require 8 mg. Once kids are 14 years old, requirements increase again slightly to 11mg for males, and 15 mg for females, due to the onset of menstruation in girls.

It's important to note that certain factors can increase a child's need for iron. For instance, rapid growth spurts, frequent physical activity, and periods of increased blood loss. Additionally, children with certain medical conditions or dietary restrictions/habits may need closer monitoring to ensure they meet their iron needs.

Low Iron Symptoms & Signs of Iron Deficiency in Kids

Iron deficiency in children can present with a range of physical and behavioural signs. While some symptoms may be subtle, others can be more noticeable. Below are some common signs of iron deficiency in kids:

Physical Symptoms

Fatigue and weakness
Pale skin, nail beds and mucous membranes.
Shortness of breath
Frequent infections
Restless leg syndrome
Pica (craving non-food items such as paper or dirt)

Behavioural and Cognitive Symptoms

Irritability and mood swings
Difficulty concentrating
Poor appetite
Decreased activity level
Delayed cognitive development

If you notice any of these signs or symptoms in your child, it is recommended to consult a healthcare professional for proper evaluation and diagnosis.

What Causes Iron Deficiency in Kids?

Iron deficiency can have multiple causes, ranging from dietary factors to underlying medical conditions. It is important to understand the reasons for low iron because this will help determine the most appropriate treatment. For example, if a child has issues with absorption, constant supplementation will not be long-lasting. More appropriate treatment would be determining why absorption is low and improving these pathways.

Below are some of the most common causes of iron deficiency and anaemia in children:

Dietary Factors

Low intake: Inadequate intake of iron-rich foods such as red meat, poultry, fish, beans, green leafy vegetables and fortified cereals
Competing nutrients: Some vitamins and minerals compete for absorption within the digestive tract, such as calcium. Consuming too much cow's milk, particularly during iron-rich meals, can reduce how much iron with actually be absorbed by the body.

Medical Conditions

Impaired absorption: Chronic diseases that affect iron absorption or utilisation, such as coeliac disease or inflammatory bowel disease
Blood loss: High levels of blood loss such as in conditions with gastrointestinal bleeding, or heavy menstrual periods in teenage girls.

Other

Intestinal parasites or worms: Intestinal parasites or worms, such as hookworms or roundworms, feed on the host's blood and iron stores, leading to iron depletion.
Other deficiencies: Vitamins such as riboflavin (B2), folate (B9) and B12 play crucial roles as cofactors in red blood cell production and iron absorption. Insufficient intake or absorption of these nutrients can impair the body's ability to maintain iron stores, even if dietary iron intake is adequate.
Rapid Growth: During periods of rapid growth, such as infancy, childhood, and adolescence, the body's demand for iron increases. If dietary iron intake does not match these increased needs, it can lead to iron deficiency.

Diagnosis of Iron Deficiency in Children

Diagnosing iron deficiency in children requires a combination of clinical assessment, medical history, physical examination, and pathology testing. This can include:

Evaluation of medical history, dietary patterns, and any family history related to iron conditions.
Physical examination may be carried out to identify physical markers of iron deficiency like pale skin, mucous membranes.

Pathology tests:

**Full Blood Count:** A FBC is a blood test that measures various components of the blood, including haemoglobin levels, hematocrit, and red blood cell markers. Low haemoglobin and hematocrit levels, along with small and pale red blood cells (microcytic, hypochromic), are indicative of iron deficiency anemia.
**Serum Ferritin Level:** Serum ferritin is a protein that stores iron in the body. A low serum ferritin level is an indicator of iron deficiency, even before anaemia develops. However, other factors, such as inflammation, can affect ferritin levels, so interpretation may require additional considerations.

Iron Studies: Iron studies include tests such as serum iron, total iron-binding capacity (TIBC), and transferrin saturation. These tests provide additional information about iron storage and transport in the body. This is important in considering why ferritin may be low and can help determine if other nutritional deficiencies are co-occurring that will affect the absorption of iron and its ability to be incorporated into red blood cells.

Treatment Options for Iron Deficiency in Children

Treating iron deficiency in children usually involves a combination of dietary changes, iron supplements, and management of underlying conditions.

Nutritional Recommendations

Encourage your child to eat a balanced diet rich in iron-containing foods such as lean meats, poultry, fish, beans, lentils, tofu, and fortified cereals.
Minimise the intake of cow's milk to prevent interference with iron absorption.
Consider incorporating vitamin C-rich foods such as citrus fruits, strawberries, and bell peppers into meals to enhance iron absorption.

Iron Supplements

If dietary changes alone are not sufficient, iron supplements may be recommended to replenish iron stores and for the prevention of iron deficiency anemia.
It is important to note that while iron is essential, an excess of iron, particularly through supplementation, can have negative impacts. Iron overload can lead to oxidative stress and promote the growth of harmful bacteria and viruses. For this reason, iron should only ever be taken following pathology testing and under the guidance of a medical practitioner.

Management of Underlying Conditions

If iron deficiency is caused by an underlying medical condition, such as celiac disease or gastrointestinal bleeding, treatment of the underlying condition is essential for long-term management.

Iron deficiency is a common but preventable condition in children that can have serious consequences if left untreated. By understanding the symptoms, causes, and treatment options for iron deficiency, you can take steps to support your child's health and well-being. Incorporating a variety of iron-rich foods into your child's diet and adopting healthy eating habits can help ensure they meet their iron requirements and support their optimal growth and development.

Disclaimer: This article is for educational purposes and does not constitute individual health advice. It is important to seek the advice to assess what is right for your child. If you have questions, speak with your primary healthcare practitioner or book a free chat here.

More about Kate Shore - Children’s Naturopath

Kate Shore is a paediatric naturopath with an interest and clinical focus on gut health, behaviour, and mental health. Kate received her Bachelor of Health Science from Torrens University and has established her practice in North Warrandyte, Melbourne, where she sees children locally and worldwide. Her approach draws heavily on supporting the gut-brain axis via nutrigenomics, microbiome testing, strong nutritional foundations, and lifestyle support. She works with a range of conditions, from anxiety and depression, ADHD and ASD, OCD tic disorders, and PANS/PANDAS.

If you want to get in touch or have any more questions about the above, you are welcome to get in contact here or make an time for a free chat here.

If you want to keep learning, keep reading the research here:

National Health and Medical Research Council. (2024). Nutrient Reference Values for Australia and New Zealand: Iron. Retrieved from https://www.nrv.gov.au/nutrients/iron
World Health Organization. (2001). Prevalence of anaemia in children aged 6–59 months(%) https://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-anaemia-in-children-under-5-years-(-)
World Health Organization. (2024) Anaemia. https://www.who.int/health-topics/anaemia#tab=tab_1
Atkins, L.A. et al. (2021) ‘Adequacy of iron intakes and socio-demographic factors associated with iron intakes of Australian pre-schoolers’, European Journal of Nutrition, 59(1), pp. 175–184. doi:10.1007/s00394-019-01897-7.