Iron deficiency in children - a guide for parents

Even a child is sometimes tired and doesn't feel like playing. However, if laziness becomes a permanent condition, parents should think about iron deficiency.

The symptoms often come on gradually. As a result, parents may not notice the change in their child's behaviour and, over time, consider it normal.
In this article, we want to provide parents with sound knowledge so that they can recognise and effectively tackle this widespread but often overlooked deficiency in their children.

1. Difference between iron deficiency and iron deficiency anaemia
2. Importance of iron for child development
3. Causes of iron deficiency in children
4. Symptoms and signs of iron deficiency in children
5. Effects of iron deficiency in children
6. Risk factors for iron deficiency in children
7. Prevention and treatment of iron deficiency
8. Conclusion

1. Difference between iron deficiency and iron deficiency anaemia

The terms iron deficiency and anaemia are often confused in everyday language. However, in order to combat the problem effectively, it is important to understand the differences and the underlying mechanisms.
Organs, muscles and the brain all need oxygen. Iron helps to distribute oxygen in the body because it is involved in the formation of haemoglobin. Haemoglobin is a building block of red blood cells and transports oxygen to the cells and organs.
In the case of anaemia (anaemia), there are too few red blood cells in the blood. As there are other causes of anaemia besides iron deficiency, anaemia caused by iron deficiency is called "iron deficiency anaemia".
If a child has iron deficiency, this does not mean that it is anaemic. However, iron deficiency can lead to anaemia.

2. Importance of iron for child development

Iron deficiency is particularly common in children up to the age of three and in adolescents. Girls are more frequently affected than boys.
Iron is essential for healthy physical and mental development and a functioning immune system in children and adolescents.
Without sufficient iron, children cannot develop healthily. At the same time, however, they need a lot of iron, especially when they are growing rapidly.
If a child suffers from iron deficiency in its first months of life, this can delay its development and have lifelong consequences. Problems such as poor vision and hearing or behavioural disorders can accompany the child in the long term.

Iron deficiency in babies

The foundations for a healthy iron balance in the child are laid during pregnancy. Pregnant women who eat a diet low in iron run the risk of the baby suffering from iron deficiency at birth. It is therefore very important that women avoid iron deficiency during pregnancy.

In the last weeks of pregnancy, the baby replenishes its iron stores. It takes the iron from the mother's iron stores. This is why many women have an iron deficiency after giving birth. For the same reason, premature babies have an increased risk of iron deficiency: due to the early birth, they have not had enough time to properly replenish their iron stores.

Iron deficiency in preschool children and schoolchildren

The risk of iron deficiency increases at pre-school age. Especially in children who consume a lot of cow's milk.
Poor performance at school, forgetfulness and difficulty concentrating can be a warning sign of iron deficiency. It should not be forgotten that iron deficiency can impair not only mental but also athletic performance. A connection with hyperactivity is also suspected.

Iron deficiency in adolescents

Iron deficiency is common in adolescents. Girls start menstruating and iron is removed from the body with the lost blood. Boys form more muscles at this age and the body also needs iron for this.

3. Causes of iron deficiency in children

Most children are born well supplied with iron. In the first six months, the amount of iron in the mother's milk decreases more and more. If the baby then receives too little iron through food, its iron stores are depleted after a few months. At six months, the child begins to grow rapidly and needs a lot of iron. Breastfeeding alone is no longer enough. If the child does not receive iron-rich complementary foods, this can be the start of an iron deficiency.
Iron deficiency in children can have many causes. However, the reasons can be divided into 3 categories:

A: The child absorbs too little iron

Iron is absorbed with food. The body cannot produce iron itself. If the child has a one-sided diet with foods low in iron, this can lead to an iron deficiency. Malnutrition is also the most common cause of iron deficiency in children and adolescents.
Certain illnesses (e.g. coeliac disease) or some medications can impair iron absorption and the child can develop an iron deficiency even though it actually consumes enough iron in its diet.

B: The child is going through a phase with a high iron requirement

Children need a particularly high amount of iron in two developmental phases:
- In the first two to three years, the child grows strongly, the blood volume increases => iron is needed for haematopoiesis.
- In the teenage years
If the child absorbs too little iron during such a phase, an iron deficiency can occur - often unnoticed.

C: The child has lost a lot of iron

High iron loss is rare in children. Iron is usually lost with the blood, for example in the event of an accident or an operation. Later in life, iron deficiency is relatively common in women due to menstruation.

4. Symptoms and signs of iron deficiency in children

The symptoms of iron deficiency vary depending on the age of the child and the severity of the deficiency or anaemia.

Typical mild symptoms of iron deficiency (with or without anaemia) in children are

• fatigue
• irritability
• weakness
• pale skin

Typical severe symptoms of iron deficiency in children are usually accompanied by anaemia:

• fast or irregular heartbeat (palpitations)
• feeling dizzy
• fast breathing (tachypnoea)

5. Effects of iron deficiency in children

Iron deficiency and in particular the resulting iron deficiency anaemia have far-reaching effects on children's health and development. The consequences vary depending on the severity of the deficiency and the age at which it occurs.

Short-term effects

The immediate consequences of iron deficiency are a noticeable reduction in physical and mental performance. The child is often tired and feels weak, which has a negative effect on their ability to learn and on their general activity. The child's attention span becomes shorter and they have difficulty concentrating. It is often first noticed that performance at school suddenly drops.

Long-term effects

The long-term consequences of iron deficiency anaemia are particularly worrying. They include:

• Impairment of cognitive development: Iron is an essential component of neurotransmitters¹ and plays an important role in brain development. A deficiency can therefore have a lasting effect on brain performance, which can lead to learning difficulties and reduced mental flexibility.
• Diminished motor skills: Iron deficiency can affect the development of motor skills, resulting in delayed motor development, coordination difficulties and reduced muscle strength.
• Mental health problems: In the long term, iron deficiency can also affect mental health. It is associated with an increased risk of mood swings, depression and anxiety.
• Developmental delays in infancy: Iron deficiency can have particularly serious consequences during this crucial phase of physical and mental development. Impairment of cognitive and physical development at this early stage can have lasting effects on the child's learning ability and general health.

Iron deficiency in children, when to see a doctor?

The symptoms of iron deficiency usually appear gradually and are sometimes difficult to recognise. Even a child who has no typical symptoms may have an iron deficiency. Pay attention to the typical symptoms and make an appointment with a doctor if you suspect iron deficiency.
See a doctor immediately if you notice the following symptoms:

• Shortness of breath
• Palpitation, rapid heartbeat
• Circulatory collapse
• Dizziness

6. Risk factors for iron deficiency in children

With a perfectly balanced diet, the iron we take in with our food is sufficient to cover our requirements. However, our modern diet with its many processed foods is also accompanied by a reduced iron content in food.
Even a (supposedly) healthy diet can have its pitfalls. Some parents are perplexed when they find out that their child has an iron deficiency. For example, the risk of iron deficiency increases with vegan and vegetarian diets.
Even if a lot of dairy products are on the menu, iron deficiency can be a consequence. Components of cow's milk (magnesium, calcium), soya milk and some plant-based foods prevent or make it difficult for the body to absorb iron.

Most common risk factors for iron deficiency in infants:

• Early birth
• Little solid food
• Nutrition with cow's milk

Most common risk factors for iron deficiency in adolescents:

• Vegetarian/vegan diet
• Consumption of too many dairy products
• High-performance sport

7. Prevention and treatment of iron deficiency

Iron deficiency can normally be prevented with targeted nutritional strategies and a conscious lifestyle. The basis for prevention and treatment is an iron-rich diet, supplemented by careful sequencing of food and drink and, if necessary, taking supplements. Please note that some foods promote or inhibit iron absorption.

Dietary recommendations

• Snacks: Avoid snacks with low nutritional value such as biscuits, white rolls and sweets. Instead, favour fruit or wholemeal rolls topped with vegetables, meat or cheese, which are natural sources of iron.
• Main meals: Opt for home-cooked meals instead of frozen pizza, microwave meals or fast food. A balanced meal contains vegetables, wholemeal products, meat and eggs - all important sources of iron.
• Drinks: Milk reduces iron absorption. Do not let your child drink milk together with iron-rich foods or iron supplements. A glass of orange juice, on the other hand, promotes iron absorption.

The daily recommended iron intake for children and adolescents can be found in the chart. The body absorbs iron most effectively from animal sources such as meat, fish and eggs. However, please note that the body can only process around 5 to 10 % of the iron ingested with food.

Food supplements and their use in children

In the case of severe iron deficiency or a diet low in iron (e.g. vegan diet), it may be advisable to take an iron supplement.

Parents should be aware of the benefits of iron supplements with microencapsulated iron. AndreaFer iron sticks are particularly suitable for children aged 12 and over. In contrast to tablets, they are very well tolerated and taste delicious, similar to raspberry sherbet powder. Children can easily handle the small sachets themselves and dissolve the powder in their mouth without water and then swallow it.

If there are signs of iron deficiency or uncertainty about your child's iron intake, it is important to consult a specialist. They can make a clear diagnosis and, if necessary, initiate customised treatment or, if necessary, recommend iron infusions for severe iron deficiency.

8. Conclusion

Iron deficiency and iron deficiency anaemia pose serious risks to children's development and health. Persistent tiredness or reluctance to play are not trivial. Take the symptoms seriously and ensure that they are diagnosed and treated quickly.

Make sure your child has a balanced diet and prevent iron deficiency before it develops. Remember that your child can only develop healthily with sufficient iron and that a lack of iron can have consequences for the child's entire life.

AndreaFer is a dietary supplement that can be taken from the age of 12. If your child is under 12 years of age, you should not administer AndreaFer on your own initiative. In this case, contact the paediatrician.