Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone. 

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Am Fam Physician. 2002;66(7):1227

What is iron deficiency anemia?

Anemia means having fewer or smaller red blood cells than normal. Iron is a key part of hemoglobin, which is the part of the red blood cell that carries oxygen from the lungs out to the rest of the body. Children can get iron deficiency anemia when there is not enough iron in their diet to make a normal amount of hemoglobin in their blood.

Should I be worried about iron deficiency anemia?

Iron deficiency anemia can cause your infant or toddler to have mental, motor, or behavior problems. These problems can be long lasting even after treatment fixes the anemia.

Who gets iron deficiency anemia and how do I prevent it?

Infants who drink cow's milk in the first year of life are at risk for iron deficiency anemia. Cow's milk is the most common dietary cause of iron deficiency in infants. Do not give cow's milk to your infant in the first year of life. Breastfed infants who do not eat iron-rich foods like iron-fortified cereal or take an iron supplement after the fourth month of life are at risk. If your child is breastfed, add some form of iron to the child's diet starting at 4 to 6 months of age, using iron-fortified cereal or vitamin drops with iron.

Toddlers (12 to 24 months of age) who drink a lot of cow's milk, have a diet low in iron, or already had iron deficiency as an infant are at risk.

If you use iron-fortified formula, do not give your child vitamin drops with iron. This combination provides too much iron and is not healthy. If you decide to stop breastfeeding before your infant is 12 months of age, use iron-fortified formula. Do not use low-iron formula.

After your child is 12 months old, if you stop breastfeeding or using iron-fortified formula, you should feed your toddler meat, chicken, fish, whole grains, enriched bread and cereal, dark green vegetables, and beans. Vitamin C is also important because it helps the body absorb iron. You should limit your child to less than 24 oz of cow's milk per day. (That's 3 cups of milk.) You might try giving your child yogurt and cheese. You also may want to continue giving vitamins with iron.

Who should be tested for iron deficiency and when?

Infants at risk for iron deficiency should be checked with a blood test at 9 to 12 months of age. Toddlers should be checked six months later and at 24 months.


Keep all products with iron stored out of the reach of your child because they can be poisonous if taken in very large amounts.

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