By Drs. Sally Robinson and Keith Bly

Iron is a mineral that the body uses to make hemoglobin, which is a pigment in the blood that carries oxygen to every part of the body. If the body does not get enough iron, then hemoglobin production decreases and this affects the production of red blood cells. A less-than-normal amount of hemoglobin and red blood cells in the bloodstream is known as anemia.

Children are at a higher risk for anemia during rapid growth periods, such as infancy and adolescence, as well as during the toddler years — between ages 1 and 3 — because toddlers stop drinking formula and eating infant cereal, which are fortified with iron.

Formula-fed infants should always take iron-fortified formula, except in rare cases of iron-metabolism defects (which needs to be diagnosed by a doctor). Switching from formula or breast milk to whole milk too soon (before the child turns 1) can put a child at risk for iron-deficiency anemia.

Anemia develops slowly, so those suffering from it don’t show any signs or symptoms at first. Signs of anemia will slowly progress and include:

· fatigue and weakness

· pale skin and mucous membranes

· rapid heartbeat

· irritability

· decrease in appetite

· dizziness or lightheadedness

Iron-deficiency anemia is often diagnosed during a routine exam, such as your child’s yearly check-up. Your child may need blood tests to determine iron-deficiency anemia. These tests include a complete blood count to reveal the following:

• low hemoglobin levels and hematocrit, which is the percentage of the blood that is made up of red blood cells
• the reticulocyte count, which measures the number of immature red blood cells being produced
• serum iron, which measure the amount of iron in the blood
• serum ferritin, which determines the body’s iron stores

Most cases of iron-deficiency anemia are due to low dietary iron intake, but changes in diet and the use of multivitamins with iron aren’t usually enough to replenish iron stores, so your child’s doctor may prescribe a separate daily iron supplement. Iron supplements should not be given to your child without consulting your doctor first. Too much iron can poison your child.

Iron is absorbed best when taken on an empty stomach, but it can occasionally cause stomachache. Children who have stomach pain when taking iron supplements may need to take them with a small amount of food, but iron should never be given with milk or drinks that contain caffeine because their ingredients interfere with iron absorption. Vitamin C has been shown to increase iron absorption, so including plenty of sources of vitamin C in your child’s diet is a good idea.

Your child’s doctor may want to repeat blood tests after a month to see if iron levels have improved. If your child responds well to treatment, the doctor may continue the supplement for several months. Once the iron levels return to a normal level, they can be maintained by providing your child with an iron-rich diet. Your doctor may want to recheck iron levels about six months after your child stops the supplement therapy.

Dr. Sally Robinson is a pediatrician in the division of children’s special services at the University of Texas Medical Branch at Galveston. She teaches medical students about caring for children with chronic medical conditions. Dr. Keith Bly is a hospitalist and assistant professor of pediatrics at UTMB.

The Your Health column is written by health and medical experts at the University of Texas Medical Branch at Galveston. The column focuses on topical health issues that we believe are of interest to your readers. It is e-mailed every Tuesday. If you have any questions about the column, or would like to suggest topics, please contact John Koloen, media relations specialist, at (409) 772-8790 or email