Feature Articles

Anemia in Children: Infants Need Their Iron

November 14, 2008
This series on Anemia in Children will discuss a few common causes and strategies for preventing anemia in children of different age groups. Part 1 focuses on iron deficiency anemia in infants (0-3 years of age). Part 2 | Part 3

The first years of an infant's life are filled with tremendous growth and development. Your baby will change more during his or her first two years than at any other time. Because of this amazing growth, children less than two years old, particularly those aged 9-18 months, are at the highest risk of any age group for developing iron deficiency anemia.1 Therefore, during this critical time it is very important for your baby to get enough calories and nutrients, including iron.

Infants and toddlers 6-24 months of age need a lot of iron to grow and develop. The iron that full-term infants have stored in their bodies from their mothers is used up in the first 4-6 months of life. After that, infants need to get iron from food or supplements. Because of this, iron deficiency anemia does not usually develop until the baby is about 9 months old. Premature and low-birth-weight babies are at even greater risk for iron deficiency anemia because they don’t have as much iron stored in their bodies.1

The WIC Program

The WIC Program provides services and information on healthy eating, nutritious foods to supplement diets, and referrals to health care for low-income woman, infants and children up to age five.

Certain toddlers are also at risk for developing iron deficiency. Children of this age tend to be fussy eaters, and may not get enough iron in their diets. According to the Centers for Disease Control and Prevention (CDC), toddlers from 1-3 years of age have a higher risk of iron deficiency. Toddlers who are overweight, Hispanic, and who are not attending day care or preschool are also more likely to be iron deficient.2

Dr. Lloyd Van Winkle, Family Practice Physician and Clinical Associate Professor of Medicine at the University of Texas stated, “The most common cause of iron deficiency anemia in children is poor dietary intake of iron and vitamins. The number of children suffering from iron deficiency anemia has declined in recent years. Improved nutritional support, such as the WIC program, has been a very positive factor in reducing anemia.”

Van Winkle quoteWhat are the symptoms of iron deficiency anemia?

Many infants with iron deficiency don't show any symptoms early because the body's stored iron is depleted slowly. If your child has anemia, you may notice that your child seems more tired, weak, and fussy than normal. According to Dr. Van Winkle, “Many mothers may notice that their child’s color just doesn’t look right, and that the child’s nail beds are no longer pink in color.” As the anemia progresses, you may recognize some symptoms in your child, including tiredness, irritability, loss of appetite, cold hands and feet, and pale skin, lips or nail beds.3

Symptoms of Anemia
in Children
  • Tiredness
  • Irritability
  • Loss of appetite
  • Cold hands and feet
  • Pale skin, lips, or
    nail beds

Dr. Van Winkle warns parents that “Anemia should be taken seriously. It is more than just tiredness; it affects the entire body, especially in growing children. It can increase your child’s risk of illness and hurt their school performance.” If left untreated, iron deficiency anemia can affect your infant’s development and behavior.3 If iron deficiency is not fully reversed, children can develop shortened attention spans, learning disabilities, and decreased social interaction, which may continue past school age.3 Fortunately there are steps parents can take to detect, prevent and treat iron deficiency anemia in their children.

How is anemia detected in children?

Anemia is usually detected when your doctor does a routine blood test at a regularly scheduled visit, usually during the sixth, ninth or 12th month visit. The blood test measures hemoglobin levels. The American Academy of Pediatrics recommends this screening for all infants.4 However, if you notice any signs of anemia, please call your baby's doctor.

How is anemia prevented?

The single most important advice Dr. Van Winkle gives mothers to help prevent anemia in their infants is to breast feed their child. If that is not possible, he recommends that their child gets an iron-fortified formula. Studies have shown that breastfeeding for the first seven months may protect babies from iron deficiency.1 The iron in breast milk is better absorbed than that from other sources because the vitamin C and high lactose levels in breast milk help iron absorption.

Just Any Milk Won’t Do
Until one year of age, give your baby breast milk or iron-fortified formula. Do not give your baby low-iron milk such as cow's milk, goat’s milk or soy milk. Drinking too much low-iron cow's milk is a common cause of iron deficiency because it contains little iron and can get in the way of iron absorption. Cow's milk may also cause problems in the intestine that could lead to bleeding.1


Starting on Solids
Once your baby starts eating solid foods at 4-6 months, it should be iron-fortified infant cereal. Continue offering iron-fortified cereal until about 18 to 24 months old.


Foods for Tots
Children from 1-5 years old should drink no more than 24 ounces of low-iron milk – such as cow's milk, goat’s milk or soy milk – daily. Solid foods should include iron-rich foods like lean meats, poultry, and fish; iron-fortified pasta, rice, and bread; leafy green vegetables; egg yolks; and legumes. Offer fruits and vegetables rich in vitamin C – like kiwi, avocado, and cantaloupe – which help the body absorb iron.

How is anemia treated in infants?

Treatment for iron deficiency anemia includes an iron-rich diet, but this may not be enough to correct anemia once it has developed. Your child may also need an iron supplement, usually given in the form of drops. Your child should not be given an iron supplement without first consulting a doctor because taking too much iron is a major cause of serious poisoning in children, according to the American Academy of Pediatrics. Read more about Iron Supplements or an Iron-Rich Diet in our other feature articles.

Iron is absorbed best on an empty stomach, but because it can cause an upset stomach, your doctor may suggest giving the supplement with food, breast milk, or formula. Do not give iron supplements with cow’s milk, because it can prevent the absorption of the iron.

Your doctor will probably recheck your child's blood counts about 1-2 months after starting treatment to make sure it is working and the anemia is getting better. It usually takes a couple of months for hemoglobin levels to return to normal, then a few more months for your child to store some additional iron. After that, your child's iron can probably be maintained with an iron-rich diet.

Recognizing and treating anemia is important for the healthy growth and development of your child. If your child is diagnosed with anemia, there are treatments available to help. If you think your child may have anemia, we recommend you see their doctor. Close communication with the doctor will help him or her provide the treatment that is best for your baby.

For more healthy eating tips and information about iron supplements, read our feature articles The Importance of Iron in Nutrition and A Patient’s Guide to Oral Iron Supplements.


  1. Centers for Disease Control and Prevention. Recommendations to Prevent and Control Iron Deficiency in the United States. MMWR 1998; 47(No. RR-3):25. Link.
  2. Brotanek JM, Gosz J, Weitzman M, Flores G. Iron deficiency in early childhood in the United States: risk factors and racial/ethnic disparities. Pediatrics. 2007 Sep;120(3):568-75. Link.
  3. Iron-Deficiency Anemia Symptoms and Diagnosis. Seattle Children’s Hospital Research Foundation. Link.
  4. Irwin JJ, Kirchner JT. Anemia in children. Am Fam Physician. 2001 Oct 15;64(8):1379-86. Link.