October 4, 2023/Children's Health

13 Symptoms of Low Iron in Kids

A lack of energy, a sore or swollen tongue and eating non-food items are signs of a deficiency

kid in class with head down on desk

I’m Popeye the Sailor Man,
I’m Popeye the Sailor Man,
I’m strong to the “finich,”
’cause I eats me spinach,
I’m Popeye the Sailor Man!

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Readers of a certain vintage might remember the cartoon strips, radio programs, television shows and movies dedicated to a jaunty, corncob pipe-wielding sailor who accessed his super strength with the help of some canned spinach.

While the cartoon didn’t age particularly well, it did have a net-positive benefit on society: It convinced children to eat spinach! While all those canned greens didn’t give us superpowers, it did increase our iron intake. And that’s no small thing, given how common iron deficiencies are in children.

Pediatric gastroenterologist Kadakkal Radhakrishnan, MD, explains what iron is, how much your child needs each day and how to spot an iron deficiency.

What is iron and why is it important?

Iron (Fe) is a mineral that our body needs to grow, develop and produce a substance called hemoglobin. Hemoglobin is a protein in your red blood cells that your body uses to carry oxygen through your body.

Our iron levels are determined by our diets. There’s an abundance of different foods that contain that all important mineral (including spinach). When we take in more than we need, our body is supposed to store the excess for use later. An iron deficiency can happen for two broad reasons:

  1. You’re not taking in enough iron to maintain your stockpile.
  2. Something is happening that’s causing your body to use more of the iron in your stockpile than it usually would.

If you’re not getting the iron you need, you’ll have low hemoglobin. That basically means that you’re not getting as much oxygen circulating in your blood as you should. While the symptoms are often subtle, they can, slowly but surely, add up to some pretty crummy health issues. More on them later.

How much iron do children need?

The amount of iron a child needs to consume in a day depends on whether or not they have dietary restrictions. That’s because the iron found in meat, fish and poultry (heme iron) is easier for your body to absorb than iron from plant-based sources (non-heme iron).

Children assigned female at birth (AFAB) also require additional iron once they start menstruating.

The National Institutes of Health (NIH) Office of Dietary Supplements’ recommended daily allowance (RDA) of iron is:

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Age
Birth to 6 months
People who eat meat
< 0.27 mg
People who eat a vegetarian diet
< 0.5 mg
7–12 months
People who eat meat
11 mg
People who eat a vegetarian diet
20 mg
1–3 years
People who eat meat
7 mg
People who eat a vegetarian diet
12.5 mg
4–8 years
People who eat meat
10 mg
People who eat a vegetarian diet
18 mg
9–13 years
People who eat meat
8 mg
People who eat a vegetarian diet
14.5 mg
14–18 years
People who eat meat
11 mg for male children15 mg for female children
People who eat a vegetarian diet
20 mg for male children27 mg for female children

Iron is essential for your child’s development, and an iron deficiency can affect your child’s health and growth — and can even lead to anemia,” Dr. Radhakrishnan warns.

Causes of iron deficiency in kids

According to Dr. Radhakrishnan, iron deficiency is relatively common among children. It usually occurs for four main reasons:

  1. Poor diet. Children are at higher risk for iron deficiency because they need more of the stuff than adults do. And don’t overdo the milk! A diet that features an excessive quantity of milk can place a child at risk for iron deficiency.
  2. Rapid growth. Kids’ growth can be unpredictable, and almost comically fast! If your child’s in the middle of a growth spurt, they’re going to need extra iron in their diet.
  3. Loss of blood. In some cases, blood loss is obvious, like when a child starts menstruating or sustains a serious injury. But it’s also common for blood loss to go unnoticed. Inflammatory bowel disease (IBD), parasitic infections and ulcers are just a few examples of conditions that can cause blood loss and — as a result — iron deficiency.
  4. Inability to absorb adequate iron from food. This can occur with conditions like celiac disease or Crohn’s disease.

13 symptoms of iron deficiency in kids

Low iron levels impact your body in many different ways, which means there are a lot of different symptoms you can keep an eye out for. Dr. Radhakrishnan says the following symptoms can all indicate a deficiency:

  1. Fatigue and overall lack of energy.
  2. Poor appetite.
  3. Eating non-food items (pica).
  4. Irritability or fussiness.
  5. Pale skin.
  6. Brittle nails.
  7. Cold hands and feet.
  8. Cracks on the side of the mouth.
  9. Red, sore, or swollen tongue.
  10. Headaches.
  11. Dizziness.
  12. Rapid breathing and/or shortness of breath.
  13. Fast heartbeat.

If your kiddo’s displaying several of these symptoms, it’s time to visit their pediatrician for a formal assessment.

Diagnosing an iron deficiency

How does the pediatrician determine if your wee one’s iron is low? According to Dr. Radhakrishnan, you can expect them to do several different things during your appointment.

The doctor will start by getting a detailed history. As part of that process, they’ll likely ask you questions about your child’s nutrition — that is, what (and how much) they’re eating. They’ll also do a physical examination. If the pediatrician suspects your child has an iron-deficiency, they’ll order blood work to confirm it.

“While the most common cause of iron deficiency is inadequate dietary intake, these tests are necessary to precisely identify the deficiency’s cause,” Dr. Radhakrishnan adds.

Treating an iron deficiency

Treatment of an iron deficiency typically involves iron supplements. Over-the-counter supplements will do the trick if the deficiency is minor. Dr. Radhakrishnan says your provider may provide prescription-strength supplements in more severe cases. It usually takes three to six weeks to build the iron reserves back up, but it could take up to three months of treatment, depending on the severity of the deficiency.

Once your child’s iron levels have been restored, the focus shifts to keeping it that way.

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“Families dealing with iron deficiencies may benefit from the help of a pediatric dietitian to improve the dietary intake of iron-containing food,” Dr. Radhakrishnan says. “Vitamin C can also help improve absorption of iron, so this supplement could be valuable in conjunction with iron-rich foods.”

Of course, diet isn’t always the root of the problem. If it’s determined that your kiddo’s iron deficiency is the result of an underlying medical condition, your provider will either treat it themselves or refer your child to a specialist for additional care.

Although rare, it’s important to note that if your child’s hemoglobin levels become dangerously low, they may require more intensive treatment.

Blood transfusions, iron injections and intravenous (IV) iron therapy all take place in a hospital,” Dr. Radhakrishnan explains.

The iron age

If a person’s iron levels are low, they produce less hemoglobin, a substance that helps red blood cells carry oxygen throughout their body. That means your entire body is affected. Symptoms can range from fatigue and cold hands and feet to behavioral issues and appetite problems. In children, a lack of iron can also inhibit growth and development.

Iron deficiency is usually the result of poor nutrition, but it can also happen if your child has a major growth spurt, has a medical condition preventing proper absorption or is losing blood for some reason.

If you suspect an iron deficiency in your child, it’s important to see their pediatrician.

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