Iron Deficiency Anemia in Children

What is iron deficiency anemia?

The most common cause of anemia worldwide is iron deficiency. Iron is needed to form hemoglobin. Iron is mostly stored in the body in the hemoglobin. About one-third of iron is also stored as ferritin and hemosiderin in the bone marrow, spleen, and liver.

What causes iron deficiency anemia?

Iron deficiency anemia can be caused by:

  • Diets low in iron. Iron is obtained from foods in our diet, however, only 1 mg of iron is absorbed for every 10 to 20 mg of iron ingested. A child unable to have a balanced iron-rich diet may suffer some degree of iron deficiency anemia. It can happen in infants around one year of age. This is mainly due to larger than normal consumption of cow's milk and an inefficient iron-rich diet. 

  • Body changes. An increased iron requirement and increased red blood cell production is required when the body is going through changes, such as growth spurts in children and adolescents.

  • Gastrointestinal tract abnormalities. Malabsorption of iron is common after some forms of gastrointestinal surgeries. Most of the iron taken in by dietary route is absorbed in the upper small intestine. Any abnormalities in the gastrointestinal (GI) tract could alter iron absorption and result in iron deficiency anemia.

  • Blood loss. Loss of blood can cause a decrease of iron and result in iron deficiency anemia. Sources of blood loss may include GI bleeding, menstrual bleeding, or injury.

What are the symptoms of iron deficiency anemia?

The following are the most common symptoms of iron deficiency anemia. However, each child may experience symptoms differently. Symptoms may include:

  • Abnormal paleness or lack of color of the skin

  • Irritability

  • Lack of energy or tiring easily (fatigue)

  • Increased heart rate (tachycardia)

  • Sore or swollen tongue

  • Enlarged spleen

  • A desire to eat peculiar substances, such as dirt or ice (also called pica)

How is iron deficiency anemia diagnosed?

Iron deficiency anemia may be suspected from general findings on a complete medical history and physical examination of your child, such as complaints of tiring easily, pale skin and lips, or a fast heartbeat (tachycardia). Iron deficiency anemia is usually discovered during a medical examination through a blood test that measures the amount of hemoglobin, or number of red blood cells, present and the amount of iron in the blood. The American Academy of Pediatrics currently recommends universal screening for anemia at one year of age with a hemoglobin test, and an assessment for risk factors associated to iron deficiency. In addition to a complete medical history and physical examination of your child, diagnostic procedures for iron deficiency anemia may include:

  • Additional blood tests for iron

  • Bone marrow aspiration and/or biopsy. A procedure that involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy), usually from the hip bones, to be examined for the number, size, and maturity of blood cells and/or abnormal cells.

Treatment for iron deficiency anemia

Specific treatment for iron deficiency anemia will be determined by your child's doctor based on:

  • Your child's age, overall health, and medical history

  • Extent of the anemia

  • Cause of the anemia

  • Your child's tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the anemia

  • Your opinion or preference

Treatment may include:

  • Iron-rich diet. Eating a diet with iron-rich foods can help treat iron deficiency anemia. Good sources of iron include the following:

    • Meats, such as beef, pork, lamb, liver, and other organ meats

    • Poultry, such as chicken, duck, turkey, (especially dark meat), and liver

    • Fish, such as shellfish, including clams, mussels, and oysters, sardines, and anchovies

    • Leafy greens of the cabbage family, such as broccoli, kale, turnip greens, and collards

    • Legumes, such as lima beans and green peas; dry beans and peas, such as pinto beans, black-eyed peas, and canned baked beans

    • Yeast-leavened whole-wheat bread and rolls

    • Iron-enriched white bread, pasta, rice, and cereals

  • Iron supplements. Iron supplements can be taken over several months to increase iron levels in the blood. Iron supplements can cause irritation of the stomach and discoloration of bowel movements. They should be taken on an empty stomach or with orange juice to increase absorption. They are much more effective than dietary interventions alone. In cases of malabsorption or intolerance, IV iron may be needed.

    The following is a list of foods that are a good source of iron. Always consult your child's doctor regarding the recommended daily iron requirements for your child.

Iron-rich foods


Approximate iron
content (milligrams)


3 ounces


Beef liver

3 ounces


Prune juice

1/2 cup



2 ounces



1/2 cup


Ground beef

3 ounces



1/2 cup


Bran flakes

1/2 cup


Pork roast

3 ounces


Cashew nuts

1/2 cup



3 ounces



1/2 cup



3 ounces



1/2 cup


Lima beans

1/2 cup


Kidney beans

1/2 cup


Turkey, dark meat

3 ounces



1/2 cup


Roast beef

3 ounces


Green peas

1/2 cup



1/2 cup





Sweet potato

1/2 cup


Green beans

1/2 cup