Iron Deficiency. Tips for prevention and "cure"

Iron is an important nutrient. It plays a key role in many of the bodies’ functions including growth, development and appetite regulation. Iron transports oxygen around the body, making it an essential mineral for sustaining life.

When the body doesn’t have enough iron children may have difficulties in concentrating, they may be easily fatigued and/or they may have a small appetite. Low iron levels amongst pre-school aged children can also impair their cognitive abilities (1). Simply put, if iron levels are low children and may find it difficult to concentrate, difficult to learn to their potential and difficult to eat the right types and amounts of food their young body needs.

Amongst teens and young adults, behavioural problems and reduced work productivity can also negatively influenced by low iron levels. (2)


Who is at risk of iron deficiency?

During times of growth the body needs extra iron. This means that toddlers and teens are at particular risk of iron deficiency. A dietitian or doctor may consider a toddler, child or teen at risk of iron deficiency if they:

  • Were born prematurely (as extra iron stores are laid down in the last trimester of pregnancy)

  • Experienced feeding difficulties in infancy or had a delayed (after 6 months) introduction of iron rich solids 

  • Eat or drink a large amount of dairy/ calcium rich foods (as this can inhibit the absorption of iron as well as making it difficult to eat enough iron rich foods

  • Live a vegetarian or vegan lifestyle

  • Eat a limited variety of foods

  • Do not regularly eat a combination of wholegrains, meat, poultry, legumes, nuts, fruit and vegetables.

  • Have a gastrointestinal condition such as medically diagnosed malabsorption

How is iron deficiency discovered?

Iron deficiency can only be diagnosed by having blood tests. A General Practitioner (GP) can arrange this test.

It is important to have an accurate diagnosis before taking an iron supplement as an excessive intake of iron from supplements can be toxic to the body.

Commonly considered “symptoms” of iron-deficiency such as pale skin, dark eye-lids, fatigue and/or white spots on finger nails ARE NOT accurate in diagnosing iron-deficiency. 


How is iron deficiency discovered?

Iron deficiency can only be diagnosed by having blood tests. A General Practitioner (GP) can arrange this test.

It is important to have an accurate diagnosis before taking an iron supplement as an excessive intake of iron from supplements can be toxic to the body.

Commonly considered “symptoms” of iron-deficiency such as pale skin, dark eye-lids, fatigue and/or white spots on finger nails ARE NOT accurate in diagnosing iron-deficiency.


How can iron deficiency be prevented?

The prevention of iron-deficiency involves a combination of:

  • Providing iron rich menu items when first introducing solids.

o   This can include legumes, red meat, cooked eggs, smooth nut butters or ground nuts, breads and cereals with added iron.

  •   Eating iron-rich foods everyday.

  •   Providing breastmilk or human-milk-supplement (formula) for the first 12 months of life

  • Ensuring toddlers, children and teens are eating “not too little, not too much” calcium rich foods.

  • Including fruits and vegetable daily. Vitamin C rich fruits and vegetables such as tomatoes, capsicum and citrus fruits help iron be more “usable” within the body

  • Avoiding black-tea, coffee and high amounts of unprocessed bran


How is iron deficiency treated?

Dealing with iron deficiency involves a combination of medical and dietary interventions. Unfortunately a diet rich in iron will not be sufficient to “un-do” iron deficiency. After a diagnosis of iron deficiency doctor will make recommendations about starting a suitable iron supplement. Iron supplements range in dosages and forms so it is important to select the right type and take the right amount. During this time it is important to ALSO eat a diet rich in iron. A dietitian can help you to understand what this is and also provide strategies for providing it to your child. Usually after about 3 months a doctor will arrange blood tests. If there has been a good improvement in iron levels most people can then stop taking their iron supplement IF they are eating good amounts of iron everyday.

In some cases supplementation and diet alone will be not sufficient to “un-do” iron deficiency and a transfusion may be required


Dietary Iron- What, How Much and When?

What.

There are two types of iron in food. Haem-iron from animal foods such as meat and poultry. Non-haem iron from plant based foods such as legumes, nuts, seeds and tofu. Haem iron is easier to absorb than non-haem iron.

Pic: V. Au, 2019

Pic: V. Au, 2019

Haem Iron Source:

  • Red meat such as beef, lamb and veal. As a simple rule, the redder the meat the higher the iron content

  • Poultry such as chicken, turkey and pork

  • Eggs

Non-Haem Iron Sources:

  • Nuts and seeds (select unsalted varieties)

  • Rolled oats (e.g. porridge or muesli) and cereals with added iron (check the label, if iron has been added manufacturers are likely to want to advertise it)

  •  Breads with added iron ( e.g. ”The One” and “WonderWhite” bread) Green leafy vegetables

  • Lentils and legumes such as baked beans, chickpeas, kidney beans

  • Tofu

  • Dried apricots & sultanas


How much.

The amount of iron a person needs depends on their age, gender and if they have a deficiency. Children (without iron deficiency) need:

Recommended Daily Intake (RDI)

7-12 months 11 mg 1-3 years 9 mg

4-8 years 10 mg 9-13 years 8 mg

14- 18 years Boys 11mg

Girls 15 mg

Due to a “weaker” absorption, a person eating only non-haem sources of iron needs about 1.8x more iron than those eating animal sources.


When

As iron is used by the body everyday, dietary iron needs to be consumed regularly.

Dietary iron needs to be included from 6 months of age and should be included throughout the lifecycle. Eating foods mainly from the core-food groups helps to ensure that toddlers, children and teens are including iron everyday.

Tips for an iron-rich diet

  Infants:

  • Include iron-rich foods at the time of introducing solids (between 4 and 6 months).

  • Infant cereals, puree meat, poultry, legumes and tofu are great first foods.

  • Introduce cooked eggs by 9 months

  • Introduce peanuts (e.g. smooth no added salt peanut butter) by 12 months

  • Include an iron-rich food at each serving of solids. E.g. Iron fortified cereal for breakfast and puree meat with vegetables at dinner. 

  • As the child progresses with finger foods, serve easy-chew iron-rich foods such as minced meats, shredded/ “pulled” poultry, diced omelette, soft cooked green vegetable and/or slow cooked meat such as casseroles.

  • Include foods only from the 5 food groups

Toddlers and young children

  • Include iron-rich snacks- dried apricots or sultanas, iron-fortified bread with nut spread, French Toast cut into “soldiers”, wholegrain crackers (e.g. VitaWeets) or vegetable sticks with hommos, boiled egg, cup of dry iron-fortified cereal such as MiniWeets, WeetBix bites or Cherrios

  • Serve both haem- and non-haem sources throughout the day

  • Ensure calcium intake is adequate but not excessive (no more than 500mL milk/ day)

  • Use slow-cooking methods, sauces, gravies and/or minced meat/poultry to make them easier to chew

  • Serve an iron rich food at each main meal

  • Limit food from outside of the 5 food groups to no more than twice per week


If your child is at high risk of iron deficiency; has been diagnosed with iron-deficiency or you have concerns regarding their overall intake Contact Us today