Iron deficiency is the only nutritional deficiency that is fairly common in Swedish children today. The risk of iron deficiency and anemia or anemia is the reason why you should breastfeed for more than about 6 months. Children who eat vegetarian diets and teenage girls with menses are other groups at risk for iron deficiency.
Why do we need iron?
Iron is needed to form hemoglobin. Hemoglobin is a substance found in red blood cells, which carries oxygen from the lungs into the body. In the absence of iron, the body cannot form enough hemoglobin, and enough oxygen cannot reach the body. A child with anemia due to iron deficiency (iron deficiency anemia in medical language) becomes pale (may be difficult to see), tired (may be difficult to notice), does not grow properly. This is not uncommon among 1-2 year olds, even in Sweden. In case of severe anemia the child becomes very pale, short of breath and has a palpitations. So severe anemia we see less often due to iron deficiency.
Swedish researchers have given iron supplements to children with birth weight 2000-2500 g and compared them with children with the same birth weight who received a placebo (inactive medicine / sugar pills) The results were presented in Paediatrics in December 2012. In this study, significantly fewer children who received 1 and 2 mg of iron per kilogram of body weight and day at 3.5 years of age had behavioral problems compared to those who received the placebo. Children's intelligence measured by IQ was the same whether or not they received iron supplements.
Symptoms of iron deficiency in children and adolescents
Iron deficiency causes symptoms only when it causes hemoglobin deficiency, which is also called anemia or anemia. Anemia can also have other causes, but iron deficiency is the most common. The symptoms of anemia are paleness and fatigue. So if a child is unusually pale and tired it is good to take a blood value (Hb) and it is low even for iron.
Iron in the mother's stomach
During pregnancy, iron is sent from the mother's blood to the baby. Therefore, it is important that the mother has enough iron in her blood. This is one of the reasons why iron levels are checked at MVC and many pregnant women are recommended iron supplements.
A large part of the baby's blood is found in the umbilical cord. For many years, the usual routine in many maternity wards in Sweden has been to cut off the blood flow in the umbilical cord as soon as the baby is born. It may be needed if the child is very weak and quickly needs help with their breathing. In November 2011, another Swedish study was published in British Medical Journal. There, otherwise healthy children were compared early (less than ten seconds after birth) and then (more than 3 minutes after birth) at the navel at four months of age. They had the same hemoglobin value, but only 0.6% of the recently studied children had iron deficiency at the age of four months, compared to 5.7% of the early studied children. No negative effects were seen by late naveling. Late naveling therefore seems to provide a supplement of blood and iron which is good for the child.
Breast milk contains everything the baby needs for the first 6 months except vitamin D, and, possibly, iron. Breast milk contains very little iron. Iron stores from pregnancy and childbirth, if they are full, usually last for 6 months of age, so current recommendations are that for otherwise healthy, full-time, normal-weight children do not provide iron supplements at all.
Children who are fully breastfed after 6 months (ie children who eat nothing but breast milk when they are 8-9-10 months) age usually 8-10 months of age are not so often affected by iron deficiency. That's why you should start introducing other foods at 6 months and preferably iron-rich foods.
It is difficult to directly compare the iron content of formula and breast milk because the iron in human milk is bound to various proteins that are absorbed more easily by the baby's intestine than the iron salts in formula. However, the formula contains much more iron than breast milk does. Formula for children from the age of 6 months contains as much iron as industrial manufactured gruel.
What food is iron rich?
Iron occurs in two forms in food. As part of the hemoglobin molecule (home iron) in meat and blood products and as mineral salt in vegetable products. The body has much easier to absorb the home iron. In addition, the "vegetable iron" competes to be absorbed in the intestine with calcium, which is found in milk products in particular.
Most iron is found in blood products and red meat, both in milligrams, and given how easily the body absorbs it industrially made baby porridge and gruel contain about as much iron per serving as red meat.
Can I iron-enrich homemade porridge?
Yes, preferably with crumbly palt bread (a blood product, so not for pure vegetarians).
I want to give my child vegetarian food, how do I do this?
Read carefully about what food to give your child. Provide iron-rich foods for both lunch and dinner (beans, green leafy vegetables). Preferably dried fruit and minced / ground nuts for breakfast. A lacto-vegetarian diet for children often tends to be rich in milk products. Try not to give milk products to all , as the calcium competes to be absorbed with the iron. Feel free to give industrial-produced gruel or porridge regularly.
If you want to give your child lacto-vegetarian food and do not want to offer industrially produced gruel, I recommend contacting a dietician to see that the child's food contains enough iron. If you want to give your child vegan food, I recommend even more to give industrially made porridge or gruel, and feel free to contact the dietician anyway. Talk to your BVC nurse if you want a dietician contact.
My teen wants to eat vegetarian
When teens want to eat vegetarian, it can be a good part of healthy development and release from parents. However, it can sometimes also be the first step in an eating disorder. Therefore, I think it is always good to go to a dietitian for dietary advice when a child wants to eat vegetarian. And if you, as a parent, think that the child is getting less food, or if the child is losing weight, seek help at the health care center, at the school health care or at the pediatrician as soon as possible.
Teenage girls with iron deficiency
Teenage girls go through menstruation, and abundant menstruation can lead to iron deficiency. Especially in the risk group are vegetarians with heavy menses. If your child or yourself has iron deficiency and menses, seek a youth clinic or gynecologist for advice. There are good ways to reduce menstruation, which can be nice in several ways.