Iron deficiency in children – causes, symptoms

Iron deficiency remains one of the most common nutritional problems among young children, despite advances in prevention and health education. The period between 6 and 36 months of age is associated with a particularly high risk of deficiency, as the rate of growth often exceeds the ability to meet dietary requirements. An effective approach to preventing and treating deficiencies requires both appropriate diagnosis and individualised nutritional recommendations, including supplementation.

1. Symptoms and diagnosis of iron deficiency
2. Prevalence and causes of iron deficiency
3. Key components for iron metabolism
4. Combating iron deficiency

Symptoms and diagnosis of iron deficiency

Current recommendations for diagnosing iron deficiency in children are based on a combination of clinical symptom assessment and laboratory indicator analysis, as the clinical picture may be non-specific or subtle, especially in the early stages of deficiency. The most commonly observed symptoms include:

• paleness of the skin and mucous membranes
• apathy
• easy fatigue
• decreased concentration
• deterioration in academic performance
• irritability
• slowed psychomotor development
• in infants, also delayed cognitive and motor development.
• Some children may experience symptoms of pica, i.e. abnormal cravings, such as eating soil, ice or paper.

When you suspect...

If iron deficiency is suspected, basic laboratory tests are recommended, primarily including haemoglobin (Hb) concentration, which allows anaemia to be detected, but is not sufficient to confirm iron deficiency as its cause. Therefore, it is important to determine iron metabolism indicators such as ferritin (the main iron storage protein in the body), transferrin, transferrin saturation (TSAT), serum iron concentration and total iron-binding capacity (TIBC).

Ferritin

Particular attention should be paid to ferritin, as its low concentration is the most specific indicator of iron deficiency, but it is worth remembering that ferritin is also an acute phase protein, which means that its level may increase in inflammatory conditions regardless of actual iron stores.

Prevalence and causes of iron deficiency

Iron deficiency remains one of the most common nutritional disorders in children aged 6–36 months, despite improvements in nutritional standards. Its prevalence in Europe varies considerably and depends, among other things, on socio-economic status, feeding method (breast milk, cow's milk, formula), region and inflammation in the body. In infants aged 6–12 months, the percentage of iron deficiency cases ranged from 2–25%, and in children aged 12–36 months from 3 to even 48%, with the highest values in Eastern Europe.

Anaemia

Iron deficiency anaemia was less common, although it reached up to 50% in Eastern European countries, compared to <5% in Western countries. Even in healthy populations of children in Western Europe, approximately 20–30% may have insufficient iron stores, despite average intake being within the recommendations.

According to data from Asia and Africa, the average prevalence of iron deficiency in children <5 years of age is 17.95% and anaemia is 16.42%, especially in children under 2 years of age, from large families and with low birth weight.

Overweight and obesity increase the risk

Interestingly, not only malnutrition, but also overweight and obesity increase the risk of deficiency. This is related to chronic inflammation and overproduction of hepcidin, which limits the absorption and release of iron from tissues. A plant-based diet, which is full of iron absorption inhibitors (such as phytic acid and polyphenols), can also exacerbate this condition. Absorption can also be impaired by changes in the gut microbiota, which, in conditions of obesity or chronic use of certain medications, loses its ability to support the availability of micronutrients.

Key components for iron metabolism

In addition to iron intake itself, certain vitamins are key to the metabolism of this element: vitamin C improves the absorption of non-haem iron and forms soluble complexes, while B vitamins – pyridoxine (B6), folic acid (B9) and cobalamin (B12) – are essential for normal erythropoiesis. Their deficiency can lead to megaloblastic anaemia, blood cell maturation disorders and inefficient use of iron, even if it is supplied in adequate amounts.

Iron requirements in children

Combating iron deficiency

A diet that prevents iron deficiency in children should include foods rich in haem iron, such as red meat, poultry and fish, which are highly bioavailable.

Don't forget vitamin C

It is also worth including sources of non-haem iron, such as legumes, green leafy vegetables and whole grain products, while remembering to consume vitamin C (e.g. from citrus fruits or peppers), which aids its absorption.

The current therapeutic approach to iron deficiency and iron deficiency anaemia in children is based mainly on oral iron supplementation, most often in the form of iron sulphate, which is effective but relatively often causes side effects in the gastrointestinal tract. Alternatives, such as polymaltose complexes and iron bisglycinate, are better tolerated, although evidence of their superior efficacy is limited.

Effective and safe doses are usually several mg/kg body weight/day, with treatments shorter than 3 months causing the greatest increase in haemoglobin, and longer treatments (over 6 months) more effectively rebuilding iron stores. It is important to remember that doses should be tailored to the individual. In cases of iron deficiency without anaemia, there are no clear treatment recommendations, although treatment may improve the child's development.

Lactoferrin

Lactoferrin is a promising option, improving haematological parameters with a lower risk of adverse effects. In addition, supportive interventions such as probiotics and prebiotics (e.g. Lactobacillus plantarum 299v) are being investigated, although their effectiveness in children remains uncertain.

Other strategies

In lower-income countries, double-fortified salt and iron-fortified cookware are also used as population-based interventions with moderate effectiveness. In some studies, East Asian herbal preparations have also shown beneficial effects, although they require further verification.

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