Iron-Deficiency Anemia

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What is iron-deficiency anemia?

Anemia happens if the level of red blood cells or hemoglobin in the blood drops below normal. Hemoglobin (HEE-muh-glow-bin) is an iron-rich protein that carries oxygen from the lungs to the rest of the body.

If your child does not have enough iron (iron deficiency), their body cannot make enough hemoglobin. If there's not enough hemoglobin, cells cannot get enough oxygen.

The anemia can vary from mild to severe.

What causes iron-deficiency anemia?
The most common reason for anemia in children is not getting enough iron in the food they eat.

Other causes of iron-deficiency anemia are:
- Heavy bleeding during a girl’s menstrual periods.
- Bleeding inside the body. Internal bleeding may happen if your child has an illness like inflammatory bowel disease or often takes medicines that make their stomach lining bleed. These include nonsteroidal anti-inflammatory drugs such as ibuprofen.
- Not being able to absorb enough iron from food. This can happen if your child has a disease of their bowel (such as Crohn's disease or celiac disease) or takes medicine that reduces acid in the stomach.
- Losing blood because of an accident or surgery.
Who is at risk for iron-deficiency anemia?
- Any child with a diet that does not include enough iron.
- Babies and teens because they are growing quickly and need more iron.
- Girls and young women who have heavy periods.
- Young children who drink a lot of cow’s milk, which is low in iron. Too much milk can make it harder to absorb iron from other foods. It also may take the place of foods that are higher in iron.
- Babies older than 6 months whose only food is breast milk. The iron that babies have stored in their bodies at birth is used up by 6 months. Breast milk does not have much iron.
- Babies who were born early (premature) or low birth weight. They have lower stores of iron in their body at birth, so will use them up early and need extra iron sooner.
- Vegetarians who do not eat foods high in iron. The iron in meat is easier to absorb than the iron in plant foods.

Cancer and Blood Disorder Care at Seattle Children's

Our team treats children, teens and young adults, including those with the hardest-to-treat cancers and blood disorders. We provide treatment options that many centers do not offer.

Symptoms of Iron-Deficiency Anemia

If your child’s anemia is mild, you may not notice any symptoms. Most children do not get symptoms unless their anemia is severe.

Your child may be more tired, weak or low-energy than normal. They may seem more fussy or irritable.

Other symptoms of iron-deficiency anemia include:

Pale skin, lips or nail beds compared to their normal color.
Being short of breath, dizzy or lightheaded.
Headaches.
Cold hands and feet.
Rapid heartbeat or irregular heartbeat (arrhythmia).
Eating nonfood items, such as paper, dirt, or ice. This is called “pica.”

When anemia is more severe or long lasting, it can lead to other health problems.

Diagnosing Iron-Deficiency Anemia

Anemia may be found during routine screening that many children have when they are 9 to 12 months old.

If your child has symptoms of anemia, the doctor will:

Ask about your child’s health
Check for signs of anemia or other health problems
Draw blood and do a test called a complete blood count (CBC)

A CBC checks:

A protein in the blood that carries oxygen (hemoglobin).
The ratio of red blood cells to total blood volume (hematocrit).
The size of your child’s red blood cells. This is called mean cell volume (MCV). Red blood cells are usually smaller in iron-deficiency anemia.
How many white blood cells and platelets your child has. Abnormal levels may be a sign of infection or another illness.

If the CBC shows that your child has anemia, the doctor may do other tests to learn:

What is causing the anemia
How severe it is
The best way to treat it

These tests may:

Look at a blood sample under a microscope to see if red blood cells look smaller and paler than normal.
Check if your child’s body is making red blood cells at the correct rate. This blood test is called a reticulocyte count.
Measure the actual level of iron in the blood, along with the level of a protein that carries iron and how much iron your child's body has stored. The measurement of stored iron is called a ferritin test.
Look for blood in your child’s bowel movement (stool) or other signs of problems in their digestive system.
Measure liver or kidney function.
Check for inflammation.
Assess for an inherited problem called thalassemia. People with thalassemia trait make less hemoglobin and have small red blood cells, but iron does not help that kind of anemia.

Treating Iron-Deficiency Anemia

After we know for sure that low iron is the cause of your child’s anemia, the doctor can suggest ways to increase red blood cells and hemoglobin to normal levels. Changes in your child's diet may be enough, but many children will need to take iron.

Changes to diet
- Giving young children less cow's milk and more iron-rich formula or other foods.
- Eating more foods that contain iron. These include meat, eggs, beans, dark-green leafy vegetables, peanut butter and cereal made from whole grains or with iron added.
- Eating foods high in vitamin C (like citrus fruit) that help your body absorb iron.
Supplements and medicines
For some children and teens, changes in diet are not enough. They may need to take iron supplements or other medicine.
- Our doctors can advise you about whether your child needs an iron supplement. The doctor will also talk with you about the right amount and how to take it. Taking iron along with vitamin C or certain foods can help your child's body absorb it. Too much iron can be harmful, but this rarely happens in children.
- In severe cases, children may need iron put into their vein by IV tube. Your child can get this treatment without spending a night in the hospital. Our outpatient infusion unit is staffed by expert nurses and is open every day.
- In girls who have heavy periods, birth control pills or other hormone treatments can help reduce bleeding when they menstruate. Read about Abnormal Menstrual Periods (PDF).
Blood transfusions

In rare cases, iron-deficiency anemia can get so severe that a child needs red blood cells from a healthy donor (a blood transfusion). Your child receives the blood through a vein in their arm. Giving your child healthy red blood cells helps them get the oxygen their body needs.

Most children need to stay overnight in the hospital to get a blood transfusion. Some can get transfusions at our outpatient infusion unit.

Iron-Deficiency Anemia at Seattle Children’s

Our Cancer and Blood Disorders team will focus on finding and treating the cause of your child’s anemia. We work with you, your child, your family and your child's primary doctor to get your child the right care. We offer a full range of services for babies, children and teens with iron-deficiency anemia.

If you would like an appointment, ask your primary care provider to refer you. If you have a referral or would like a second opinion, contact the center at 206-987-2106.

Providers, see how to refer a patient.

The experts you need are here

While most iron-deficiency anemia can be managed by your child’s primary care provider, Seattle Children’s can help if your child’s anemia is not improving on oral iron therapy, you are having a hard time giving iron to your child or their anemia comes back after treatment.

Our doctors are nationally known for diagnosing and treating children who have blood disorders. The doctors who will guide your child’s care are board-certified in pediatric oncology-hematology. This means they are approved to give the special care your child needs and they constantly expand their knowledge about blood disorders.

Our doctors are skilled at telling this type of anemia from other types, like thalassemia, which causes a long-lasting anemia that is not related to lack of iron.

We can help find out if some other condition is affecting your child's iron level. If your child needs care for some other illness, we can help connect you and your child's primary care provider to other specialists. For girls with iron-deficiency anemia from heavy menstrual periods, we work with Seattle Children’s Adolescent Gynecology experts to help lessen their blood loss. Many cases of iron deficiency beyond the toddler years result from a problem in the digestive system, such as poor absorption of iron or bleeding in the bowel. Our Gastroenterology specialists help care for those children.
Compassionate, complete care

We carefully monitor your child’s health and provide treatments as needed. We offer the most advanced care in the region, including nutrition guidance, medicines and blood transfusions. For children with severe anemia, we use a form of IV (intravenous) iron that most hospitals do not offer. It gives a larger dose of iron in 1 infusion instead of 4 or more. This avoids extra doctor visits and treatments.

Seattle Children’s has the experts to treat health problems that severe anemia may cause. These may include infections, heart problems or slowed growth.

We care for your whole child. We don’t just treat their disease. As needed, your child’s team will include child life specialists, social workers and experts in nutrition, pharmacy and emotional health. Read more about the supportive care we offer.
Among the nation’s best children’s hospitals

Our specialty is treating children’s conditions while helping them grow up to be healthy and productive. Our physician-scientists help set national standards for care of young people with blood disorders.

Children do not react to illness, injury, pain and medicine in the same way as adults. They need — and deserve — care designed just for them. Our experts focus on how treatments today affect growing bodies in the future. We plan your child’s treatment based on years of experience and the newest research on what works best — and most safely — for children.
Support for your whole family

Having a child with iron-deficiency anemia can be stressful. We help take positive steps right away by offering appointments within 1 to 3 days to new patients with urgent needs. If needs are not urgent, new patients can be seen in 1 or 2 weeks.

During visits, we take time to explain your child’s condition. We help you fully understand your treatment options and make the choices that are right for your family.

We help your child and your family through the challenges of this condition and connect you to community resources.

At Seattle Children's, we work with many children and families from around the Northwest and beyond. Whether you live nearby or far away, we can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Read about our services for patients and families.