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Am Fam Physician. 1998;57(10):2512-2514

Iron deficiency anemia is now uncommon in children during the first year of life. The promotion of breast feeding, along with the increased use of iron-fortified formulas and foods, has greatly curtailed this problem. These nutritional interventions came in response to earlier studies which showed delayed mental and psychomotor development in children who were deficient in iron. Studies of iron deficiency between the first and third years of life have reported a prevalence of 3 to 15 percent. Eden and Mir attempted to determine the prevalence of iron deficiency in children one to three years of age who were followed from July 1995 through June 1996.

Children between 12 and 36 months of age who visited the offices of four pediatricians in the New York City area were enrolled in the study. All children were from urban lower or middle socioeconomic groups. Racial distribution was 40 percent black, 40 percent Hispanic and 20 percent white. Excluded were children with a history of chronic illness, blood dyscrasia, prematurity or a febrile illness at the time of the visit. Venous blood samples were obtained, from which hemoglobin, ferritin, free erythrocyte protoporphyrin (FEP) and lead levels were measured. A hemoglobin level less than 11 g per dL (110 g per L) was used to define anemia. Ferritin levels less than 10 ng per mL (10 mg per L) represented iron depletion, and FEP levels greater than 35 mg per dL (0.62 mmol per L) demonstrated iron deficiency.

A total of 504 children were initially enrolled in the study. However, after excluding children with hemoglobin levels less than 11 g per dL (110 g per L) but normal ferritin and FEP levels, 485 children remained in the final analysis. Of this group, 86 children (18 percent) were iron depleted, 32 (7 percent) were iron deficient without anemia, and 48 (10 percent) had iron deficiency anemia. These results demonstrated that 35 percent of the children from the study population had some degree of iron insufficiency.

The authors conclude that there is a significant prevalence of iron deficiency in children between one and three years of age. They believe that possible explanations for this include switching children from breast milk or iron-fortified formulas to regular cow's milk, using adult-type non-iron-fortified cereals rather than iron-fortified infant cereals, and a decreased appetite for solid foods paired with an increased intake of juices. The authors cite data showing that iron deficiency during the second year of life prevents adequate brain growth and adversely affects development. They recommend that some form of supplemental iron be given to all children through at least the second year of life.

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Copyright © 1998 by the American Academy of Family Physicians.

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