Abstract
Iron deficiency is not just anemia; it can be responsible for a long list of other manifestations. This topic is of great importance, especially in infancy and early childhood, for a variety of reasons. Firstly, iron need is maximum in this period. Secondly, diet in infancy is usually deficient in iron. Thirdly and most importantly, iron deficiency at this age can result in neurodevelopmental and cognitive deficits, which may not be reversible. Hypochromia and microcytosis in a complete blood count (CBC) makes iron deficiency anemia (IDA) most likely diagnosis. Absence of response to iron should make us look for other differential diagnosis like β thalassemia trait and anemia of chronic disease. Celiac disease is the most important cause of true IDA not responding to oral iron therapy. While oral ferrous sulphate is the cheapest and most effective therapy for IDA, simple nonpharmacological and pharmacological measures can go a long way in prevention of iron deficiency.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Brittenham GM. Disorders of iron metabolism: Iron deficiency and overload. In: Hoffman R, Benz Jr EJ, Shattil SJ, editors. Hematology Basic Principles and Practice. 4th ed. New York: Churchill Livingstone; 2005. p. 481.
Conrad ME, Umbreit JN. Iron absorption and transport-an update. Am J Hematol. 2000;64:287–98.
Kumar A, Rai AK, Basu S, Dash D, Singh JS. Cord blood and breast milk iron status in maternal anemia. Pediatrics. 2008;121:e673–7.
Calvo EB, Galindo AC, Aspres NB. Iron status in exclusively breast-fed infants. Pediatrics. 1992;90:375–9.
Ziegler EE, Fomon SJ, Nelson SE, Rebouche CJ, Edwards BB, Rogers RR, et al. Cow milk feeding in infancy: further observations on blood loss from the gastrointestinal tract. J Pediatr. 1990;116:11–8.
Sutcliffe TL, Khambalia A, Westergard S, Jacobson S, Peer M, Parkin PC. Iron depletion is associated with daytime bottle-feeding in the second and third years of life. Arch Pediatr Adolesc Med. 2006;160:1114–20.
Oski FA, Honig AS, Helu B, Howanitz P. Effect of iron therapy on behaviour performance in nonanemic, iron deficient infants. Pediatrics. 1983;71:877–80.
Akman M, Cebeci D, Okur V, Angin H, Abali O, Akman AC. The effects of iron deficiency on infant developmental test performance. Acta Pediatr. 2004;93:1391–6.
Thibault H, Galan P, Selz F, Preziosi P, Olivier C, Badoual J, et al. The immune response in iron-deficient young children: effect of iron supplementation on cell-mediated immunity. Eur J Pediatr. 1993;152:120–4.
Galan P, Thibault H, Preziosi P, Hercberg S. Interleukin 2 production in iron-deficient children. Biol Trace Elem Res. 1992;32:421–6.
Ekiz C, Agaoglu L, Karakas Z, Gurel N, Yalcin I. The effect of iron deficiency anemia on the function of the immune system. Hematol J. 2005;5:579–83.
Gera T, Sachdev HP. Effect of iron supplementation on incidence of infectious illness in children: systematic review. BMJ. 2002;325:1142.
Gwamaka M, Kurtis J, Sorensen B, Holte S, Morrison R, Mutabingwa TK, et al. Iron deficiency protects against severe plasmodium falciparum malaria and death in young children. Clin Infect Dis. 2012;54:1137–44.
Oppenheimer SJ, Gibson FD, Macfarlane SB, Moody JB, Harrison C, Spencer A, et al. Iron supplementation has been reported to increase the prevalence and effects of malaria: report on clinical studies in Papua New Guinea. Trans R Soc Trop Med Hyg. 1986;80:603–12.
Smith AW, Hendrickse RG, Harrison C, Hayes RJ, Greenwood BM. The effects on malaria of treatment of iron deficiency anemia with oral iron in Gambian children. Ann Trop Paediatr. 1989;9:17–23.
Ianotti LL, Tielsch JM, Black MM, Black RE. Iron supplementation in early childhood: health benefits and risks. Am J Clin Nutr. 2006;84:1261–76.
Mebrahtu T, Stolzfus RJ, Chwaya HM, Jape JK, Savioli L, Montresor A, et al. Low dose daily iron supplementation for 12 mo does not increase the prevalence of malarial infection or density of parasites in young Zanzibari children. J Nutr. 2004;134:3037–41.
Menendez C, Kahigwa E, Hirt R, Vounatsou P, Aponte JJ, Font F, et al. Randomised placebo controlled trial of iron supplementation and malaria chemoprophylaxis for prevention of severe anemia and malaria in Tanzanian infants. Lancet. 1997;350:844–50.
Brown WD, Dyment PG. Pagophagia and iron deficiency anemia in adolescent girls. Pediatrics. 1972;49:766–7.
Maguire JL, de Veber G, Parkin PC. Association between iron-deficiency anemia and stroke in young children. Pediatrics. 2007;120:1053–7.
Zehetner AA, Orr N, Buckmaster A, Williams K, Wheeler DM. Iron supplementation for breath-holding attacks in children. Cochrane Database Syst Rev. 2010. doi:10.1002/14651858.CD008132.pub2.
Schilling RF. Anemia of chronic disease: a misnomer. Ann Intern Med. 1991;115:572–3.
Suominen P, Motttonen T, Rajamaki A, Irjala K. Single values of serum transferring receptor and transferring receptor ferritin index can be used to detect true and functional iron deficiency in rheumatoid arthritis patients with anemia. Arthritis Rheum. 2000;43:1016–20.
American Academy of Pediatrics. Iron. In: Kleinman RE, Greer FR, editors. Pediatric nutrition. 7th ed. Elk Grove Village: American Academy of Pediatrics; 2011. p. 449.
Hallberg L, Brune M, Rossander L. Effect of ascorbic acid on iron absorption from different types of meals. Studies with ascorbic acid rich foods and synthetic ascorbic acid given in different amounts with different meals. Hum Nutr Appl Nutr. 1986;40:97.
Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. Committee opinion No. 543: timing of umbilical cord clamping after birth. Obstet Gynecol. 2012;120:1522–6.
Adish AA, Esrey SA, Gyorkos TW, Jean-Baptiste J, Rojhani A. Effect of consumption of food cooked in iron pots on iron status and growth of young children: a randomised trial. Lancet. 1999;353:712–6.
Kotecha PV. Nutritional anemia in young children with focus on Asia and India. Indian J Community Med. 2011;36:8–16.
Conflict of Interest
None.
Source of Funding
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Subramaniam, G., Girish, M. Iron Deficiency Anemia in Children. Indian J Pediatr 82, 558–564 (2015). https://doi.org/10.1007/s12098-014-1643-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-014-1643-9