This post is by regular contributor Naomi Cook.
Two pregnancies, endless months of breastfeeding, running a couple of marathons and a lot of training in between left me a little lacking in the Iron Department. Iron deficiency makes me very tired, susceptible to infection and gives me tell tale dark circles under the eyes that even the best make up can’t hide. With a bit of effort however, my deficiency is pretty simple to overcome. But what about toddlers? You may be surprised to learn that toddlers and preschoolers are most at risk of developing an iron deficiency over any other age group.
What is Iron Deficiency?
Iron is used in the body in a variety of different forms for a number of different metabolic and neurological processes. 3, 7 It is for example, used in the brain to help cells formulate the fatty sheath on nerves 3, 7; this makes neurological processing faster. It is also important for forming haemoglobin which is used in the blood to carry oxygen around the body.
Sustained erosion of iron stores can lead to Iron Deficiency Anaemia; this will impair oxygen transport around the body. But, very importantly, Iron Deficiency is thought to permanently effect the development of the brain of a young child;
“Recent studies show that even transient iron deficiency without anaemia (can result in) irreversible negative effects to the brain.” 1
Studies show that toddlers with iron deficiency and iron deficiency anaemia may suffer long term defects including cognitive, motor, emotional and behavioural changes. 2, 3, 5, 6, 7, 12 These include impaired learning ability, decreased academic achievement and lower scores for mental and motor development. 1, 2, 5 10
An individual with iron deficiency is also at increased risk of infection 1, 9
Why are toddlers at a risk of Iron Deficiency?
Natural Stores: At 6 months of age iron stores become depleted 10, 12, then the baby must consume enough dietary iron to prevent deficiency from occurring. 11
Diet: Toddlers can have poor dietary intake, 3, 7, 8 as well as fussy eating habits, poor appetites, they are also transitioning to an adult diet that may be lower in iron than their ‘fortified’ diet of infancy. 9 Meat intake also tends to be low in preschoolers. 9
Growth: Toddlers need more iron in relation to body size than at any other point in their lives due to their fast rate of growth. 2, 3, 7, 8, 9
Excess Consumption of Milk:
a. Exclusive breastfeeding beyond six months – without solid food intake
b. The introduction of cow’s milk as the main drink before twelve months of age 8, 11, 12 – cow’s milk is not fortified in iron like infant formula
c. The giving of milk and juice in a bottle after the age of 18 months – this leads to a higher consumption of milk/fluid resulting in a reduced appetite for solids. 2, 9, 10
Yikes! It ‘s pretty scary reading how vulnerable toddlers are to developing an iron deficiency, so what can we do to help prevent it;
Prevention and Iron Boosting Tips
1. Haem Iron found in red meat, poultry and fish is easier to absorb than Non-Haem Iron found in other foods.
2. Some iron rich foods include – red meat, egg yolk, lentils, wholegrain cereals, dried fruit such as apricots and figs, prune juice, tomato paste, baked beans, sweet potato and quinoa.
3. Be savvy: Develop a few tactics for iron rich meals/snacks. Eating iron rich food at the same time as a food high in calcium will hinder the body’s absorption process. 4 Eating iron rich food with vitamin C will facilitate iron absorption. 4, 9
- For breakfast offer something rich in calcium like cheese on toast, fruit smoothie or yogurt rather than serving iron fortified cereal with milk. Then, offer the cereal as a ‘snack’ all by itself at morning tea. Put the “cereal crisps” in a little pot without the milk and give vitamin C rich orange juice as a drink. Or you could offer beans on wholegrain toast for breakfast with apple juice then offer milk or a yoghurt mid morning.
- If serving meat or lentil soup for dinner, serve with vegetables and then fruit for dessert rather than yoghurt or ice cream. Save the yoghurt or milk as a bed time snack a little while later.
- Bake vegan muffins with iron fortified cereal or cooked quinoa and dried fruit as ingredients. Experiment with non dairy cooking fats such as ‘coconut oil’ and nut/oat milks.
- There are other inhibitors of iron absorption such as: Oxalates, Phytates, 12 Tannins, Polyphenols and phosphates. 9 Getting bogged down with these makes meal planning very difficult but something interesting to note is that high iron spinach is also very high in oxalates, making the iron very difficult to absorb.
- If you are very concerned about how to increase your childs dietary iron, visiting a nutritionist for advice may be helpful.
4. Give iron fortified cereals to children whenever you can for as long as you can. Look for brands of porridge and cereals that are fortified.
5. Seek advice from your child’s doctor regarding appropriate iron rich supplements : There are currently some iron rich products available on the market suitable for children. “Spa Tone” 14 is an iron rich water, which according to the manufacturers is suitable from age two. “Floradix” 15 is an iron and vitamin B rich supplement which manufacturers state is suitable for over twelve months.
6. Aim to have your child drinking from a beaker rather than a bottle by 12-18 months of age. Ask your early childhood nurse or pediatrician about the daily recommended amounts of milk for your child so you avoid giving too much, or too little.
If you suspect that your toddler is low in iron you should take them to the doctor. Please note: Iron supplements in high doses are toxic. Only a doctor should ever recommend iron supplements for a child. Even at non-toxic doses iron supplements can have unpleasant gastro-intestinal side effects.
You may be lacking in the Iron Department too! If you are feeling lack lustre, why not get your own iron levels checked? As self sacrificing mums we all too frequently focus on the health of our children and forget our own.
Do you have any tips for iron rich meals and snacks suitable for the fussy toddler?
DISCLAIMER: The information contained in this article should NEVER be used as a substitute for the advice of a licensed physician. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please see a physician if you think you or your child are unwell. This author has no competing interests.
- Bamberg R (2008) Occurrence and Detection of Iron Deficiency Anaemia in Infants and Toddlers Clincial Laboratory Science: Anaemia in Selected Populations 21:4 pp225-232
- Brontanek J, Gosz J, Weitzman M, Flores G (2007) Iron Deficiency in Early Childhood in the United States: Risk Factors and Racial/Ethnic Disparities Pediatrics 120: 568-575
- Cleghorn G (2007) The Role of Red Meat in the diet for children and Adolescents Nutrition and Dietetics 64:4 pps141-s146
- Harris S (2002) The Effect of Calcium Consumption on Iron Status Nutrition in Clinical Care 5:5 pp231-235
- Hurrell R (2010) Use of Ferrous Fumarate to fortify food for infants and young children Nutrition Reviews 68:9 pp522-530
- Kumar K M (2001) Screening for Anaemia In Children: AAP Recommendations – A Critique Pediatrics 108:3 p1-2
- Lozoff B, Beard J, Connor J, Felt B, Georgieff M, Schallert T (2006) Long-Lasting Neural and Behavioural Effects of Iron Deficiency in Infancy Nutrition Reviews 64:5 pps34-s43
- Soh P, Ferguson E, McKenzie J, Homs M, Gibson R (2004) Iron Deficiency and Risk Factors for lower iron stores in 6-24 month old New Zealanders European Journal of Clinical Nutrition 58 pp71-79
- Stanner S (2003) Iron Deficiency in Infancy and Childhood British Nutrition Foundation: Nutrition Bulletin 28: pp221-225
- Sutcliffe T, Khambalia A, Westergard S, Jacobson S, Peer M, Parkin P (2006) Iron Depletion is associated with daytime bottle feeding in second and third years of life Archives of Pediatric and Adolescent Medicine 160:1114-1120
- Male C, Persson L, Freeman V, Guerra A, Van’t M, Hof, Haschke F, and the Euro-Growth Iron Study Group (2001) Prevalence of iron deficiency in 12-mo-old infants from 11 European areas and influence of dietary factors on iron status (Euro-Growth study) ACTA PÆDIATR 90 pp492-498
- Philips F (2005) Vegetarian Nutrition British Nutrition Foundation: Nutrition Bulletin 30 pp132-167
- Wharton 1999 Review: Iron Deficiency in Children Dectection and Prevention British Journal of Haematology 106: 270-280