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Iron deficiency and anemia in children

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.

The birth

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.

breastfeeding

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.

Read more about taster portions and introducing other food here

Formula then?

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.

You can see how much iron different foods contain on the Swedish Food Agency's page here. 

Can I iron-enrich homemade porridge?

Yes, preferably with crumbly palt bread (a blood product, so not for pure vegetarians).

Recipes for homemade iron enriched baby porridge can be found here. 

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.

Read more:

Taste portions - to start eating other than breast milk or substitute

Stop breastfeeding - how do you do and when is it time?

You can find all posts about food for children here

You can find all posts about childhood diseases here

Easily prepared healthy food for children

Iron deficiency and anemia in children
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21 thoughts on “<trp-post-container data-trp-post-id="191">Järnbrist och blodbrist eller anemi hos bebisar, barn och ungdomar</trp-post-container>”

  1. Hey! If you want to raise your child lacto-vegetarian but do not give industrial porridge / gourd, does it work to give homemade porridge that is iron-enriched in a vegetarian way? It circulates some such recipes on the internet that seem good to the uninitiated (myself), but I'm thinking about one thing: if iron from vegetarian issues is absorbed worse in the body, then a homemade vegetarian porridge that achieves 3 mg iron is taken up worse in the baby's body than the 3 mg of iron added in industrial porridge? Or is such a recipe OK ?? Thanks in advance for answers!

    1. Hey!
      Don't know the internet recipes, but 3 mg of iron in homemade porridge is supposed to correspond to 3 mg of iron in industrial porridge. It is not home iron (from blood) in industrial porridge.

      Greetings
      Cecilia

  2. There are good recipes and good information on the appropriate diet in the booklet
    "Green baby food", nutrition and vegomat and
    “Green Food for Pregnant and Child Families”
    by Åsa Strindlund and Elisabeth Kylberg!

    Easy to add meat and fish if you wish, of course!

  3. Hey! I also wonder why you do not give iron supplements that drip in Sweden (have understood that you give it to Danish children when they are 6-12 months provided they do not eat a certain amount of enriched compensation per day). Instead, all parents are referred to enriched porridge! For me who wanted to breastfeed for a long time, baby fever felt unnecessary and the baby did not like. I would rather have given drops to some fruit flour and let go of a bad iron conscience. We eat vegan diet.

    1. Hey!

      As a vegan, I think that iron drops in a fruit flour sound like a good solution. You can buy Niferex iron drops without prescription. They contain 1.5 mg of iron per drop. Children are recommended a diet of 8 mg of iron per day, so for a vegan diet I would recommend giving 4-6 drops daily as supplement if you do not provide iron-enriched porridge or flour.

      Greetings
      Cecilia

  4. Our three-month-old was born almost four weeks premature and has received niferex from the start. However, we have not received any directives on how long he should eat this. Is it until he starts down real food that applies or what would you recommend? Asked at BVC without getting a proper answer.

  5. Hey!
    I give my baby homemade oatmeal porridge. Pumpkin kernels should apparently contain strong iron. Is it a good alternative to iron enrich the porridge with?

    Mvh Sanna

    1. They are hard and sharp and it sounds difficult for a baby with no cheek teeth to handle. So no. How much iron they contain I have not checked.

  6. Hi. If you want to make your own baby porridge that is vegetarian, you can add custom flour in the porridge, eg oatmeal porridge. We make our own porridge and then from 1-1 / 2 dl oatmeal and 1 tbsp tailor flour, 2-2.5 dl water. Has worked great for us as our daughter has totally refused both industrially made porridge and gruel.

  7. Hi Cecilia! Thanks for a very good and interesting blog! One reason I have is why we can't get "iron drops" that we get vitamin D drops that we can give to our children. I know that, for example, in Denmark, iron drops such as vitamin D drops are given to children until they are six years old.

  8. Thanks for the reply! As I wrote earlier, it is not true with my experiences as a help mom and many years of hanging on breastfeeding forums. Maybe because the ones I have the most contact with are healthy mother-child-couples, and the ones you see doctors are with you for some reason. Could it be that you only ask about breastfeeding and other eating habits when you see that the child has iron deficiency, but that you do not pay attention to other, predominantly breastfed children who do not suffer from any deficiencies? After all, there are many children who are just eating and tasting food without getting any directly measurable amounts for several months during the second half of the year.

    1. It is certain that we see different children Marit! And of course it is true that we only delve into what the child eats and does not eat when there are no problems with growth or nutritional deficiencies etc.

  9. Hi Cecilia and thanks for a nice and educational blog! I have read with interest and wonder just one thing: Do you have any source of _many_ children being healed for 6 months suffering from iron deficiency? That's not true with my experience.

    1. Hi Marit! Thank you for your comment! I wonder if we're talking about the same thing. I agree with you that children who are cured for 6 months and are otherwise healthy are not so often affected by iron deficiency (although it does occur, we find some iron deficiency in the children's hospital of infants who are looking for something else). What I wrote and after your comment has clarified is that children who are cured after 6 months are not so rarely affected by iron deficiency a few months later. It is not about so many children who are cured at 8-10 months, most of them have started with other foods in some form. This is based on my own experience, which, according to older pediatrician colleagues, fits well with theirs.

  10. Just a note about the iron in breast milk, it is certainly not a large amount, but extremely readily absorbed by the body. There is probably some to read about it on the Amningsblog or Sagogrynets blog.

    1. Hi Cecilia
      Vet du hur pass vanligt det är med järnbrist hos barn i 6-7 års åldern? Jag hittar att protein brist och järn brist är den vanligaste näringsbristen hos våra barn enligt WHO men inte direkt på deras hemsida, studie dylikt som stödjer det. Enligt min sons dietist är det extremt vanligt hos barn som är sk selektivare med maten.
      Med vänlig hälsning, E

    2. Har inga siffror på hur vanligt det är. Men barn som är selektiva i maten och inte äter något rött kött eller berikad välling/mjölkersättning får regelmässigt järnbrist. Som tur är brukar ju selektiva barn i väldigt många fall just gilla köttbullar, korv och/eller välling. Proteinbrist är extremt ovanligt hos friska barn i ett höginkomstland som Sverige.

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