Symptoms of Iron Deficiency in Children
Iron deficiency anemia in children primarily manifests as fatigue, decreased motor activity, reduced social interaction, shortened attention span, and pallor, with the most concerning long-term consequence being potentially irreversible developmental delays and behavioral disturbances if severe and prolonged, particularly in infants and preschool children. 1
Clinical Manifestations by Severity
Mild Iron Deficiency Anemia
- Most children are asymptomatic in mild cases 2
- Pallor is the most frequent presenting feature, though only 41% of parents report it while 77% of physicians detect it on examination 3
- Low energy and fatigue that can limit physical activity 1
Mild to Moderate Iron Deficiency Anemia
- Poor appetite (reported in 29% of cases) 3
- Fatigability and lassitude 2
- Lethargy and exercise intolerance 2
- Irritability and dizziness 2
- Shortened attention span 1
- Decreased work capacity 1
- Pica (reported in 22% of cases) 3
Severe Iron Deficiency Anemia
- Tachycardia 2
- Shortness of breath and diaphoresis 2
- Poor capillary refilling 2
- Reversible cardiomyopathy in extreme cases 4
- Gastrointestinal involvement including leaky gut syndrome or exudative enteropathy 4
Neurodevelopmental and Behavioral Consequences
The most critical concern is that iron deficiency anemia in infants (0-12 months) and preschool children (1-5 years) results in developmental delays and behavioral disturbances including decreased motor activity, reduced social interaction, and impaired attention to tasks. 1
- These developmental delays may persist past school age (beyond 5 years) if the iron deficiency is not fully reversed 1
- The impairment of intellectual performance and cognitive function can be irreversible even following correction of the anemia 2
- Iron deficiency anemia also increases the gastrointestinal tract's ability to absorb lead, contributing to lead poisoning in children 1
Common Pitfalls in Recognition
- Parents frequently miss pallor (only 41% report it), making physician examination critical 3
- Children may present with non-specific symptoms like poor appetite or fatigue that can be attributed to other causes 3
- Severe cases can present with hemoglobin levels as low as 1-2 g/dL, often associated with excessive cow's milk consumption (>24 oz daily) 4, 3
Treatment Approach
Prescribe 3 mg/kg per day of elemental iron administered between meals for presumptive iron deficiency anemia after confirming positive screening with repeat hemoglobin or hematocrit. 1, 5
- Provide dietary counseling emphasizing maximum 24 oz daily of cow's milk and introduction of iron-rich foods 1, 5
- Recommend iron-fortified cereals and vitamin C-rich foods to improve iron absorption 1, 5
- Repeat screening after 4 weeks: an increase of ≥1 g/dL in hemoglobin or ≥3% in hematocrit confirms the diagnosis 1, 5
- Continue iron treatment for 2 additional months after confirmation, then recheck hemoglobin 1
- Reassess approximately 6 months after successful treatment completion 1
Age-Specific Considerations
- Infants and toddlers (13-36 months) are at highest risk, with 84% of severe cases occurring in this age group 3
- Adolescent girls (12-19 years) show 2-4% prevalence of iron deficiency anemia, making them the highest risk group among school-age children 1
- School-age children and adolescent boys require screening only if they have history of iron deficiency anemia, special health-care needs, or low iron intake 1