Disclaimer: This material is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it. It is not intended to provide medical advice, diagnosis or treatment, nor does it replace the advice or counsel of a doctor or health care professional. Reference to a specific commercial product or service does not imply endorsement or recommendation of that product or service by CPCMG.
This article contains information about anemia, focusing on iron-deficiency anemia due to low intake of iron in the diet.
Anemia can make your child look pale and feel cranky, tired, or weak. Though these symptoms may worry you, the most common causes of anemia—such as iron deficiency—are easy to treat, especially when anemia is detected early.
What is anemia?
When the number of red blood cells in the body decreases below normal for your child’s age. These cells are important because they carry oxygen to different parts of the body.
Anemia commonly develops during periods of rapid growth, like in the first year of life and during adolescence.
Your child may become anemic if their body:
Does not produce enough red blood cells.
This can happen if your child does not have enough iron or other nutrients in their diet. This is called iron-deficiency anemia and is the focus of this article.
Destroys too many red blood cells.
This happens when a child has an underlying illness or has inherited a red blood cell disorder (like sickle-cell anemia).
Loses red blood cells through bleeding.
This can either be obvious blood loss, such as heavy menstrual bleeding, or long-term low-grade blood loss, perhaps in the stool.
What are the signs and symptoms of anemia?
Common signs and symptoms:
Pale or yellow skin.
Pale cheeks and lips.
The lining of the eyelids and the nails may look less pink than normal.
Irritability.
Mild weakness.
Getting tired more easily or taking naps more frequently.
Pica: Eating non-food items, such as ice, dirt, clay, paper, and cardboard. This usually stops after the anemia is treated
Children experiencing red blood cell destruction may become jaundiced (yellowing of the skin or eyes) and have urine that looks dark like tea.
Uncommon signs and symptoms indicating more severe anemia:
Shortness of breath.
Rapid heart rate.
Swollen hands and feet.
Headaches.
Dizziness and fainting.
Restless leg syndrome – commonly described as feeling the need to move the legs, especially when laying down. Some kids describe feeling itching, tingling, or crawling sensation.
How is anemia diagnosed?
In most cases, with a simple blood test done in the office. A small sample of blood will be taken from your child’s finger or toe.
Sometimes anemia is found when a child has labs done for another reason.
The American Academy of Pediatrics recommends screening all children for anemia at their 12-month well-child check and at other well-child checks if needed.
How is anemia treated?
Mild anemia can sometimes be treated by making changes to the foods your child eats.
Your child’s healthcare provider might decide to treat your child’s anemia with an iron supplement. Some things to know about this medication:
Sometimes children taking iron complain of stomach pain. Try to have your child eat something before taking the medicine.
Sometimes children taking iron experience constipation. Learn more about constipation here.
Have your child drink orange juice when they take the medicine - this will make the medicine work better.
Do not give the medicine with milk, calcium supplements, and antacids – it won’t work as well.
If your child’s teeth become stained from the medicine, you can brush them with baking soda.
Sometimes your child’s bowel movements can change colors – even looking green or black. This is very common and not dangerous at all.
If too much is taken, it can be very dangerous. Keep the medication out of reach and only give iron if your child’s healthcare provider tells you to.
Your child will need to have a follow-up visit with their healthcare provider in 1 month to make sure their anemia is improving. Usually, children will need to take their iron supplement for a few months.
How can I prevent anemia?
Make sure that your child eats a well-balanced diet.
Some children with diet restrictions might need to take a supplement to prevent anemia. Let your child’s healthcare provider know if your child has a restricted diet.
The amount of iron your child needs in their diet depends on their age and sex.
Infants | Birth-6 months 7-12 months | 0.27 mg/day 11 mg/day |
Children | 1-3 years 4-8 years 9-13 years | 7 mg/day 10 mg/day 8 mg/day |
Adolescent Males | 14-18 years | 11 mg/day |
Adolescent Females | 14-18 years | 15 mg/day |
Infants and toddlers:
If your baby is fed breastmilk (at the breast or in a bottle):
They will have an adequate supply of iron until at least 4 months of age.
At 4 months of age breastfed infants should receive an iron supplement until they are eating iron-rich foods.
If your baby is formula-fed:
The American Academy of Pediatrics recommends iron-fortified formulas. Give your baby formula with added iron. Iron is found in most formulas available in the United States.
Using a low-iron formula can result in anemia. It should not be used unless your child’s healthcare provider tells you to.
Iron-fortified infant cereals are commonly introduced to babies between 4 and 6 months of age.
After 6 months of age, offer meats along with foods high in Vitamin C (like citrus fruits, broccoli, kiwi, leafy greens, bell peppers, strawberries, tomatoes) to enhance iron absorption. Make sure to offer foods in sizes and consistencies that are not choking hazards.
Do not give your baby cow’s milk until they are 12 months old. Giving cow’s milk too early can cause blood in the stool and decrease the amount of iron absorbed from foods.
After introducing cow’s milk, try to limit your child to no more than 16-20 ounces per day.
Older children and teens:
Feed older children a well-balanced diet with foods that contain iron.
Many grains and cereals have added iron but check the labels to be sure.
Other good sources of iron include red meat, egg yolks, beans, peas, raisins, sweet potatoes, and molasses.
Vitamin C helps the body absorb iron found in foods. Encourage your child to eat foods high in Vitamin C like citrus fruits, leafy greens, strawberries, broccoli, tomatoes, and bell peppers.
If possible, use cast-iron pans for cooking.
Contact your child’s healthcare provider if:
Your child is showing symptoms of anemia.
Your child has been prescribed an iron supplement and is unable to take the medication.
You are worried about your child’s picky eating.
You have other questions or concerns.
This publication was adapted from information in the American Academy of Pediatrics patient education materials.
Reviewed by: AR D.O., TT D.O. | 03/2024