Doctors’ Notes


Anemia & Iron Deficiency

They checked my child’s blood today and told me she is anemic. What does that mean? Should I be worried?  What can I do about it?

What is Anemia?

Anemia is a condition when a person does not have enough red blood cells to carry oxygen to all of the body’s tissues. Sometimes this can be from a genetic variation, where a person makes small or abnormal red blood cells, but the most common cause of anemia is not having enough iron in the body.

Iron is needed to make hemoglobin, the protein inside of red blood cells that holds the oxygen molecule. If a person’s body doesn’t have enough iron, it can’t make enough hemoglobin or red blood cells. This, in turn, means that his or her blood can’t deliver all of the oxygen that the body needs. Anemia can make you feel tired and have reduced energy levels. For infants and young children, whose brains are still rapidly developing and need lots of oxygen, it can also impair cognitive development if the situation persists.

Causes, Testing, & Treatment

Iron deficiency can be the result of blood loss or intestinal problems that prevent adequate absorption of iron from foods, but by far the most common reason, especially in children, is not having enough iron in the diet. Full-term newborns usually have a good store of iron at birth, since they receive a lot of iron from Mom near the end of a pregnancy. Babies born prematurely often need to take additional iron supplements beginning very early on, since they missed that late-pregnancy iron deposit.  It’s helpful for breastfeeding Moms to continue taking their prenatal vitamins, so that both Mom & baby get enough iron, among other important nutrients. Breast milk and formula both provide good amounts of iron for the first few months of life, but by 4-6 months, babies need to take in more iron than these sources typically provide.

Starting solid foods with iron-rich options can help to prevent iron deficiency in older infants. For your reference, I’ve included a list of iron-rich foods below. We also have lots of great Nutrition Notes on our web site about starting solid foods for infants and healthy diets for older children, where you can  find these iron-rich foods listed. Vegetarian & vegan diets can be completely healthy for infants, children, and teens, but parents will need to pay special attention to ensure adequate iron intake, as well as protein & B vitamins.

All babies should also be screened for anemia between 9 & 12 months of age, to make sure their dietary intake of iron is adequate.  Teenaged girls should also be screened, 1-2 years after the onset of menstrual periods, to make sure they’re not losing too much iron with menstrual bleeding. We typically do this with a simple finger-stick blood draw in the office, and have the result ready for you in a few minutes. If the office result shows borderline or low levels of hemoglobin, then the provider who saw your child will usually order a more detailed blood test, to be drawn at a lab. If that still shows anemia, then the provider will recommend a diet higher in iron, and maybe a multivitamin with a little bit of iron, or a prescription dose of iron supplementation, depending upon the details of your child’s results.

Iron is best absorbed when eaten with foods rich in vitamin C (citrus fruits, peppers, strawberries, melons, and tomatoes are good choices). It’s not absorbed as well with high levels of calcium — so avoid giving with milk or dairy foods. Too much of a good thing can also be a problem; you should follow the directions carefully and keep any iron supplements out of reach of all of the children in your home, since an iron overdose can make a child very sick, and can even be fatal.

Once we have a treatment plan for your child’s anemia, we will re-check his blood count, usually in about 6-12 weeks. With this re-check, your child’s provider may also check iron levels, red blood cell production rates, and/or screen for genetic hemoglobin variations, depending upon the details of your child’s history and blood count. Making sure that your child’s bodily iron stores are replenished and maintained is important to her physical growth and  cognitive development, but with appropriate treatment & follow-up, most children recover completely from iron-deficiency anemia.

Iron-Rich Foods

  • Beans & lentils
  • Soybeans & tofu
  • Seafood, especially mollusks (clams, mussels, oysters, scallops)
  • Salmon, tuna, sardines
  • Liver  – chicken, pork, turkey, lamb, beef (small cubes of liverwurst are actually great finger foods for babies, who often gobble them down, even though most adults’ first reaction is, “yuk!”)
  • Lean red meat – especially beef & lamb
  • Nuts & seeds – especially squash & pumpkin seeds, almonds, cashews, peanuts, pine nuts, & hazelnuts
  • Nut & seed butters count too!
  • Whole grains & iron-fortified cereals
  • Dark green leafy vegetables – spinach, kale, chard
  • Broccoli, peas, asparagus
  • Olives, mushrooms
  • Dried fruits – apricots, raisins, prunes, currants, figs
  • Berries, coconut
  • And just for fun – dark chocolate & real maple syrup!

Dr. Sarah Springer, a shareholder in the practice, is the Medical Director of Adoption Health Services of Western Pennsylvania.