Based on recommendations from the AAP and risk factors in certain patients, many clinics screen infants for anemia around one year of age. Parents often have questions about why we need to draw blood (not an easy procedure at this age) and wonder what anemia really is. Here’s my answer with links to other good resources on this topic.

What is anemia?

Healthy Children defines anemia as, “a condition that occurs when there are not enough red blood cells or hemoglobin to carry oxygen to the other cells in the body. The body’s cells need oxygen to survive.”

Anemia can occur for a variety of reasons. One of the most common reasons in children is iron deficiency. Red blood cells need a protein called hemoglobin to work well. Hemoglobin in turn contains iron. So, if there is not enough iron in the body red blood cells can’t do their job.

What are the symptoms of anemia?

Many parents become understandably concerned when told that their child has anemia. But, anemia can range from quite mild (almost normal) to severe (requiring hospitalization). Children with mild anemia may not have any symptoms at all (one of the reasons it is important to screen). Children with moderate to severe anemia may seem more tired than usual or have decreased energy. Anemia can cause the desire to eat non-food items such as dirt (aka pica). Children with anemia may be pale or have a fast heart rate.

If your doctor tells you that your child has a low red blood cell count, that they have low hemoglobin or hematocrit, or that they have low iron, this is likely their way of telling you that your child is anemic.

Are certain young children more at risk for anemia?

As stated above, iron deficiency is one of the most common reasons a young child may have anemia. There are a number of reasons a child may become iron deficient.

–Premature infants: Babies receive a lot of iron from their mother’s stores during the last trimester of pregnancy. When babies are born prematurely, they don’t receive all of this goodness and are therefore at higher risk of iron deficiency. These babies also sometimes have higher need for blood tests and this can make anemia worse. If your baby was born prematurely, ask your neonatologist or pediatrician whether they might need an iron supplement.

–Young full term infants: If your young infant drinks formula, it should be fortified with iron. Breastmilk contains some iron, and babies absorb it very well, but it may not be enough to prevent anemia after mom’s stores wane (around 4-6 months of age). When starting solid foods, it is important to start giving iron rich foods (see below) to replete a baby’s supply.

–Toddlers who drink a lot of milk. Milk is low in iron. Toddlers who drink a lot of milk tend to eat less iron-rich foods. In addition, milk can sometimes cause small amounts of bleeding in the gut. These factors sometime combine to cause significant anemia. Dr. Stuppy has a great explanation here.

Why is this important?

Preventing and treating anemia is important for a number of reasons. Anemia can make kids tired, less active, and irritable. This makes it tough for them to grow, develop, and learn. Having sufficient iron stores is also thought to be essential for normal neurodevelopment. Severe anemia makes it hard for the body’s organs to function well.

How can you prevent iron deficiency in your child?

-Eat sufficient iron rich foods during pregnancy. This helps both mom and baby.

-Make sure your older infant or toddler has iron rich foods in their diet. These include:
Meats: including liver, pork, and beef
Legumes: including black, pinto, navy beans, and lentils
Egg yolks
Vegetables and greens: including kale, broccoli, spinach, and asparagus
Iron-fortified grains: including pasta and cereals
Dried fruits: including prunes and apricots

-Wait until one year of age to introduce cow’s milk into your child’s diet and limit your toddler’s milk intake to less than three cups per day.

How is iron deficiency anemia treated?

-If the anemia is mild, your doctor may recommend iron rich foods and a follow up blood test to make sure it is improving.

-If the anemia is moderate, your doctor may recommend iron drops (ferrous sulfate) to be taken daily until your child’s anemia improves. Iron drops are generally very well tolerated. The most common side effect is constipation. If this occurs, try to compensate by increasing water and high fiber fruits and vegetables in your child’s diet. If the problem persists, talk with your doctor.

The good news is that iron deficiency is preventable and iron deficiency anemia is treatable.

There are many other reasons that a child or adult may become anemic. If anemia persists despite adequate iron stores, your health care provider will consider other causes.

For more information:
Iron and Iron Deficiency (review for all ages) from the CDC:
General review of anemia in children from Children’s Hospital Wisconsin