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Kids and Anemia

Does your kid dawdle over his food? Does he cry about everything? Is he spacey and clumsy?

Does your lean, active child get short of breath during games? Does she get frequent nosebleeds or bruise easily? Does she have pale skin and/or pale lips the same color as her cheeks?

Is your toddler small for his age, growing slowly or not hitting milestones? Is he a picky eater? Does he love to drink milk and eat little else?

If any of these sound like your kid, it's possible he is anemic. How does it happen?

- Iron stores become low in infants around 6 months of age, and they may not enjoy iron-rich foods at this age

- Many toddlers love milk and it provides a convenient source of calories, while having no iron. Same for cheese. My kids go through cereal-and-milk phases.

- Many kids are picky about fruits and vegetables, and miss this source of iron and vitamin c that aids in iron absorption

- Many kids don't love red meat, or they prefer meats that contain less iron.

Over many years of talking with many parents as their doctors confirmed low hemoglobin after noticing pale lips or poor growth, it's clear that "low energy" is not the distinguishing sign of anemia in kids. The average kid has more energy that the average adult, and will desperately keep up with the kids around him as long as possible. Instead of acting tired, he will be fragile and sensitive, the way we all are when we push through fatigue for a long time.

Of course there could be other reasons for all of the above symptoms, and it's worth looking into other reasons if diet changes don't help within a month or two. If you are going to get a doctor's assessment, ask for more than just the hemoglobin test, because in most people hemoglobin only declines after iron stores have been depleted for some. time.

According to the National Institute of Health, iron deficiency progresses through three stages, with hemoglobin being low only in the third stage.

  1. Mild deficiency or storage iron depletion: Serum ferritin (iron) concentrations and levels of iron in bone marrow decrease.

  2. Marginal deficiency, mild functional deficiency, or iron-deficient erythropoiesis (erythrocyte production): Iron stores are depleted, iron supply to erythropoietic cells and transferrin saturation decline, but hemoglobin levels are usually within the normal range.

  3. IDA: Iron stores are exhausted; hematocrit and levels of hemoglobin decline; and the resulting microcytic, hypochromic anemia is characterized by small red blood cells with low hemoglobin concentrations.

Practically, the way to figure out whether your kid needs more iron is to give him more iron-rich foods and an easy-to-digest supplement such as Floradix or Zarbees. Even if your child had a genetic iron-loading disorder and was destined to absorb too much iron and become overloaded as an adult (a condition called hemochromatosis), it's almost impossible to feed a growing kid too much nutritious food.

Some ways to change food habits:

- Limit dairy significantly. A bowl of cereal for breakfast and quesadilla for lunch, as convenient as they are, will not help iron stores.

- Eat eggs and /or meat at every meal if possible, particularly red meat.

- Eat beans, which have a good amount of iron and go well with meat.

- Eat sardines and oysters if you like them.

- Serve fruits and vegetables rather than crackers or bread, for vitamin c and iron.

- Try pate and liver, your kids may like them.

- Cashews and dark chocolate have plenty of iron.

Most whole foods have some amount of iron in them. A good variety of fish and meat, with its highly absorbable iron, and other foods with less absorbable iron, is the best way to ensure good iron levels over time. Limiting dairy and eating fewer grains ensures that kids will be hungry enough to eat the iron-rich foods they need.

Remember that any step forward is progress. Pick a starting point that's easy, even if that's just a supplement with no diet changes at first. Once your kid's appetite improves it can be easier to get her eating meat, fruit and vegetables. When we're anemic, we absorb a ton of iron from foods, so you should see improvement in a matter of weeks with food and supplements.

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