From the Guidelines
A 2-year-old female with persistently low iron and vitamin B12 levels should be evaluated by a pediatrician for appropriate supplementation and to identify underlying causes. For iron deficiency, I recommend ferrous sulfate drops at 3-6 mg/kg/day of elemental iron divided into 1-2 doses, given between meals with vitamin C to enhance absorption, as the child is at a high risk for iron deficiency due to their age, as indicated by 1. For vitamin B12 deficiency, oral cyanocobalamin at 1-5 mcg/day is typically sufficient, though initial intramuscular injections may be needed in severe cases. These deficiencies require investigation of potential causes including:
- inadequate dietary intake (especially in children with restricted diets like vegetarian/vegan diets)
- malabsorption disorders (celiac disease, inflammatory bowel disease)
- or genetic conditions A complete blood count, ferritin, transferrin saturation, and methylmalonic acid levels can help assess severity, as suggested by the need for routine screening for anemia among populations of children at higher risk for iron deficiency 1. Dietary modifications should include iron-rich foods (meat, fortified cereals, beans) and B12 sources (animal products or fortified foods), and the risk for iron deficiency drops after age 24 months, when the growth rate of children slows and the diet becomes more diversified 1. Treatment typically continues for 3-6 months after normalization of levels, with regular monitoring, as these nutrients are crucial for neurological development, red blood cell production, and overall growth in young children, making prompt treatment essential.
From the FDA Drug Label
Deficiency has been recognized in infants of vegetarian mothers who were breast fed, even though the mothers had no symptoms of deficiency at the time. Patients following such a diet, should be advised to take oral vitamin B12 regularly The need for vitamin B12 is increased by pregnancy and lactation. Intake in children should be in the amount (0.5 to 3 mcg daily) recommended by the Food and Nutrition Board, National Academy of Science-National Research Council.
The 2-year-old female's persistently low iron and low Vit B12 levels may be due to a dietary deficiency, especially if the mother is vegetarian and breastfed the child. Vitamin B12 deficiency can occur in infants of vegetarian mothers, even if the mother has no symptoms. It is essential to ensure the child is receiving adequate vitamin B12 and iron intake, as recommended by the Food and Nutrition Board, National Academy of Science-National Research Council, which is 0.5 to 3 mcg daily for children 2.
From the Research
Persistently Low Iron and Low Vit B12 in 2-Year-Old Female
- The condition of persistently low iron and low Vit B12 in a 2-year-old female can be caused by various factors, including inadequate intake, inadequate bioavailability, or malabsorption 3.
- Iron deficiency is the most common cause of anemia worldwide, and its prevalence is highest among preschool-aged children 4.
- Vitamin B12 deficiency can affect individuals at all ages, but most particularly elderly individuals, infants, children, adolescents, and women of reproductive age are also at high risk of deficiency in populations where dietary intake of B12-containing animal-derived foods is restricted 3.
- A study found that treatment with iron increased significantly serum folate and vitamin B12 from baseline in young adult women with iron deficiency anemia 5.
- Another study found that the levels of vitamin B12 and folic acid in newborns were related to the levels of vitamin B12 and folic acid in their mothers, and that development of low vitamin B12 stores in newborns and the development of vitamin B12 deficiency during infancy can be prevented by preventing vitamin B12 deficiency during pregnancy 6.
- Reduced levels of iron, folate, vitamin B12, vitamin D, zinc, and magnesium are common in untreated celiac disease patients, and removal of gluten from the diet leads to histological recovery and normalization of iron, vitamin, and mineral levels in the majority of patients 7.
Possible Causes and Solutions
- Inadequate intake of iron and vitamin B12 can be caused by a diet lacking in animal-derived foods, and can be solved by increasing consumption of these foods or by taking supplements 3, 4.
- Malabsorption of iron and vitamin B12 can be caused by celiac disease or other conditions, and can be solved by removing gluten from the diet or by taking supplements 7.
- Iron supplementation has been shown to increase hemoglobin and ferritin levels in 2 to 5 year olds, but more research is needed to determine its effects on clinically important outcomes 4.
Diagnostic Biomarkers
- Diagnostic biomarkers for vitamin B12 status include decreased levels of circulating total B12 and transcobalamin-bound B12, and abnormally increased levels of homocysteine and methylmalonic acid 3.
- Iron deficiency can be diagnosed by measuring hemoglobin and ferritin levels, and by performing a physical examination 4.