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Anemia in Infants and Toddlers

15 August 2024

Iron deficiency anemia is a condition that causes a low supply of oxygen to the body’s tissues. This condition is considered the most common nutritional deficiency in infants and toddlers, and over time may impair normal development.

To prevent iron deficiency anemia in infants, it is recommended to increase the consumption of foods rich in iron and provide an iron supplement according to the directions:

Nutrition: in infants under six months the recommendation is to breastfeed exclusively, because iron absorption from breastmilk is significantly higher than from infant formulas. However, it is important to note that if your infant consumes infant formula, you should make sure to choose a cow milk-based infant formula enriched with iron (unless there is a medical direction for other infant formula types).

From the age of six months, it is advised to incorporate iron rich foods into the menu, such as beef, red turkey, chicken, fish and legumes and also combine fruits and vegetables rich with vitamin C, which improve iron absorption. It is important to make sure that dairy products do not serve as the main food source under the age of one year because they are low in iron.

Iron supplement: the recommendation is to provide 7.5 milligrams per day from the age of four to six months and 15 milligrams from the age of six months to eighteen months.

Even if there is no concern of iron deficiency, it is important to take a blood count for infants from the age of 9 months to one year. After getting the test results, you will receive instructions on whether it is necessary to increase the dosage. In any case, it is important to continue providing an iron supplement until the age of eighteen months.

What else do you need to know about the causes of iron deficiency anemia? What are the symptoms of iron deficiency and how can you prevent these conditions at a young age?

The function of iron in our body

The human body needs a sufficient quantity of iron to produce adequate amounts of hemoglobin and red blood cells, which are responsible for transporting oxygen to all organs of the body. In addition, iron allows for normal growth and developmental processes, and for the functioning of the immune system in the present and later in life.

Prevention of iron deficiency anemia in infants

In Israel, the iron deficiency anemia rate in infants and toddlers is higher than that in other western countries (for example, in the United States) and there are populations in which the iron deficiency anemia rate in infants at the age of one year exceeds 25%. For this reason, it is important to make sure that all infants and toddlers from the age of 4 months consume iron rich foods (according to their age) and get an iron supplement (according to the dosages set forth below). An iron supplement for infants is provided as drops.

From the age of 9 months to one year, it is important to take a blood count for infants, even if there is no concern of iron deficiency. After getting the test results, you will receive directions on whether it is necessary to increase the dosage. In any case, the administration of the iron supplement must continue up to the age of eighteen months.

Recommendations for preventing iron deficiency anemia

Nutrition

Breastfeeding: iron absorption from breastmilk is significantly higher than from infant formulas. Therefore, the recommendation is to breastfeed exclusively from birth to the age of six months and continue breastfeeding along with supplementary food ("solids") until the age of two years and longer. If the infant is fed infant formula, it is a good idea to choose a cow milk based infant formula enriched with iron (unless there is a medical indication for other infant formula types).
Iron rich food: from the age of six months, when feeding with supplementary food starts, it is advised to provide iron rich foods. It is recommended to cook meals at home and combine different food types according to the recommended frequency:
- Meat: beef, red turkey and chicken, 2-3 times a week.
- Fish: about twice a week.
- Legumes: it is important to consume legumes daily, such as: lentils, peas, beans, chickpeas, broad beans, soy beans and tahini.
Improving absorption of iron from plant based foods: the consumption of plant based foods and fruits and vegetables rich with vitamin C, such as red pepper, tomato, citrus fruits and melons, improves iron absorption.
Avoiding cow milk until the age of one year: the recommendation is not to administer cow milk to infants below the age of one year. In addition, because dairy products are low in iron, it is not a good idea to make them a key ingredient in the infant's nutrition.
Unsweetened dairy products as supplementary food only: you can give infants from the age of six months unsweetened dairy products, but because they are low in iron, it is important to make sure they do not constitute the main ingredient in the menu.
Avoiding tea leaf based drinks: it is better to avoid giving infants beverages that are based on tea leaves, such as black or green tea, to prevent iron absorption disorders.

Iron supplement for infants

The Ministry of Health’s recommendation is to provide an iron supplement to infants from the age of 4 months, irrespective of the amount of iron they get from food. These are the following dosages:

From the age of 4 months to six months: administer 7.5 milligrams per day.
From the age of one year to eighteen months: administer 15 milligrams per day. According to the results of the blood count performed near the age of one year, you will receive directions on whether it is necessary to increase the dosage. In any case, it is important to continue administering an iron supplement until the age of eighteen months.
Preterm infants: it is recommended to provide a daily dosage of 2 milligrams per kilogram of body weight from the age of two weeks (chronological age), and not more than 7.5 milligrams, until the age of six months (chronological age). From the age of six months, do not administer more than 15 milligrams. Iron should be administered until the age of eighteen months, unless otherwise directed in the discharge letter from the neonatal intensive care unit or the attending physician.

Do not forget

To ensure that you do not forget to provide the iron supplement every day, it is a good idea to have a fixed time to administer it. Bath time is recommended, because after you undress your infant, there is no chance that the clothes will get dirty. To avoid dosing errors, it is advised to administer the iron using a teaspoon rather than dripping it directly into the infant’s mouth.

Note

It is important to make sure the supplement bottle stays out of reach of children. Once you are done using it, make sure to cap the bottle completely.

Diagnosing iron deficiency and anemia

To diagnose anemia, it is necessary to check the iron blood level using a blood count. From the age of 9 months to one year, as part of the routine follow-up at the Family Care Center, all infants are referred to a blood count. According to the results, it will be decided whether to increase the supplement dosage to a therapeutic dose or keep it as is until the age of eighteen months.

The symptoms of iron deficiency

Iron deficiency anemia may appear at varying degrees and is not always identifiable, so it is advised to perform a blood count to verify the state of the body’s iron reserves. In addition, it is important to pay attention to a number of symptoms that may indicate a disorder: