Parenting Advice From Your Physicians at Kaiser Permanente

Parents often wonder if their child or teen might be anemic and if we should do a blood test to make sure they’re healthy. Often, the answer is yes.

Many kids are anemic, and the most common cause of anemia is not eating a diet high enough in iron. Iron is essential in rapidly growing babies, toddlers, and teens.

The body uses iron to make red blood cells, which carry oxygen to all the cells of the body. If there’s not enough iron to create those red blood cells, it results in iron-deficiency anemia. This can cause decreased energy, growth delay, learning, and focus problems in young children, and other symptoms in older kids.

Iron-deficiency anemia is more common in:

• Premature infants
• Babies fed low-iron formula or plain cow’s milk before age 12 months
• Babies not fed high-iron foods (like iron-fortified infant cereals) after age 6 months
• Children who drink more than 24 ounces of any kind of milk a day
• Athletic teens—especially females
• Teens with heavy menses
• Vegetarians or others on restrictive diets that are low in iron

While milk can be a valuable part of a child’s diet, providing protein, calcium, and vitamin D, too much milk can cause problems. Cow’s milk is a poor source of iron and can make it hard to absorb iron from other foods. Therefore, it must be given in moderate amounts and only to children over age one. Some toddlers really like to drink lots of milk, but parents need to limit them to no more than two 8-ounce cups of milk per day.

To learn if a child is anemic, we will often ask about their diet to see how high in iron it is. We also do a physical exam to look for pale skin, lips, and conjunctiva (lining of the eyelids) and listen for a rapid heart rate. Many kids who are mildly anemic have no symptoms, but if the anemia is more severe, it may cause symptoms.

Anemia symptoms in children include:

• Tiredness and weakness
• Irritability
• Exercise intolerance (increased fatigue or shortness of breath when exercising or actively playing)
• Headaches
• Dizziness or feeling light-headed
• Poor appetite
• Eating non-foods like paper, dirt, ice, or chalk

If a blood test confirms that your child is anemic, we’ll recommend treatment based on the degree of their anemia. In all cases, you should focus on feeding them an iron-rich diet.

We often suggest giving kids a daily multivitamin with iron or prescribe an iron supplement for several months to refill their body’s iron stores. Don’t give the vitamin or supplement with milk. It’s ideal to give it with a drink high in vitamin C, like orange juice. If we offer a prescription, we usually recheck their blood count in 1 to 3 months.

Prevent anemia in children

There are several ways to help prevent your child from getting iron-deficient anemia.

• If your baby is breastfed, be sure to start giving them foods high in iron starting by 6 months. One good choice is iron-fortified baby cereal mixed with breast milk.
• If your baby is formula fed, only offer iron-fortified formula. Low-iron formulas are dangerous.
• If your baby was born prematurely, ask your pediatrician if they need an iron supplement. This is often given to premature babies from the beginning of their life.
• Starting with their first foods, feed your child a diet high in iron. Iron-rich foods include red meat, beans, lentils, leafy green vegetables, poultry, nuts, seeds, dried fruits, and fortified cereals.
• Also offer foods high in vitamin C, like citrus, strawberries, broccoli, tomatoes, and bell peppers. Vitamin C helps the body absorb iron.
• Bring your child to their pediatrician for regular well-child checkups.

Resources for Parents

My Doctor Online

Iron Deficient Anemia

American Red Cross

Iron Rich Foods

Centers for Disease Control and Prevention

Iron