Iron-deficiency anemia in babies

My baby seems pale and weak. Could it be anemia?

Yes. In fact, the most typical signs of anemia are pale skin and tiredness. Other signs include rapid heartbeat, irritability, loss of appetite, brittle nails, and a sore or swollen tongue. But it's common for a baby with anemia not to have any symptoms at all.

What is anemia, and what causes it?

People become anemic when red blood cells don't carry enough oxygen to the tissues in their body. Various conditions can cause anemia, including an inherited illness called sickle cell anemia, but iron deficiency is the most common cause.

The human body needs iron to make hemoglobin, the oxygen-carrying red pigment in blood. If your baby doesn't get enough iron, he'll have fewer red blood cells – and the ones he has will be smaller, so his body tissues will receive less oxygen than they should.

Children are especially susceptible to anemia during periods of rapid growth, when they need extra iron that they don't always get. But iron-deficiency anemia doesn't happen overnight – it's caused by a relatively severe deficiency that develops over time.

Iron deficiencies can happen for several reasons, including not enough iron in the diet, ongoing blood loss (in the intestinal tract, for example), and poor absorption of iron.

Is anemia dangerous?

It can be.

In addition to the symptoms mentioned above, a child who's anemic could suffer permanent mental and physical problems. (While an iron deficiency can be corrected, the mental and physical impairment is not always reversible.)

Iron deficiency also makes kids more susceptible to lead poisoning and infection.

Is my baby at risk for anemia?

Between 9 and 24 months, all children are at high risk for anemia, but these babies are at highest risk:

Premature and low-birth-weight babies age 2 months old and older. Full-term infants are born with iron stores accumulated during the last months in utero. These stores can last four to six months. The iron stores of babies born prematurely may last only about two months.

Babies who drink cow's milk before their first birthday. Cow's milk is low in iron. It also interferes with the body's absorption of iron, and it may replace some iron-rich foods in the diet. Milk can also irritate the lining of a baby's intestine, causing bleeding. This slow loss of blood in the stool – along with low iron intake – can cause anemia.

Breastfed babies who receive no iron-fortified foods after 4 months of age. The iron in breast milk is absorbed three times better than the iron in formula, but around the time a baby starts eating solids, he needs additional iron in the form of fortified cereals and other iron-rich foods.

Full-term, formula-fed babies who aren't given iron-fortified formula. Most baby formula is fortified with iron, however.

Should I call the doctor?

The American Academy of Pediatrics (AAP) recommends that babies be screened for anemia at 12 months, or earlier if they were born prematurely. But if you notice any signs of anemia, do call your baby's doctor.

To determine whether your baby is anemic, the doctor will do a blood test to measure levels of hemoglobin and hematocrit (percentage of red blood cells in the blood).

Can I prevent my baby from becoming anemic?

You can prevent your baby from developing iron deficiency anemia. Here's how:

• If your baby was born prematurely or at a low birth weight, talk with his doctor about iron supplements.
• Until he's a year old, give your baby breast milk or iron-fortified formula, not cow's milk.
• If your baby is 4 months old and breastfed and not yet eating solid foods, the AAP recommends giving him an iron supplement of 11 milligrams (mg) per day until he starts eating iron-rich foods.
• Once your baby starts eating solids, feed him iron-fortified cereal, and eventually iron-rich foods like lean meats, poultry, and fish; iron-fortified pasta, rice, and bread; leafy green vegetables; egg yolks; and legumes. (See our age-by-age guide for more details about when to feed your baby various foods.)
• Offer plenty of fruits and vegetables that are rich in vitamin C, such as kiwi, avocado, and cantaloupe). Vitamin C helps the body absorb iron.

How is anemia treated in babies?

It's important to boost your baby's iron intake once he's eating solids, but dietary changes aren't always enough to correct anemia. He may also need an iron supplement, usually given in the form of drops.

Iron is absorbed best on an empty stomach. But because iron can cause tummy upset (and has an unpleasant taste, besides), your doctor may suggest giving the supplement to your baby with food, breast milk, or formula. Your doctor will probably recheck your child's hemoglobin/hematocrit levels after he has been on the supplement for a month or two.

It usually takes a couple of months for the blood count to return to normal, and then another six to 12 months to replenish iron stores. After that, they can probably be maintained with an iron-rich diet.

Should I give my baby an iron supplement, just in case?

Iron supplements are helpful in many instances, but too much iron can be poisonous, so always consult your doctor before giving your baby iron supplements. Doctors often recommend extra iron for breastfed babies starting at age 4 months. Get all the details in our expert's answer to the question "Does my baby need an iron supplement?"

If you do have iron supplements in the house (or vitamins that contain iron), make sure you keep them locked up and well out of your young child's reach. Iron is a leading cause of accidental poisoning.