Treating Iron Deficiency Anemia

Iron deficiency is still on the list as a cause of anemia in children, though we see it somewhat less often than we did 10-20 years ago.   Typically children with iron deficiency anemia present at 9 months - 2 years of age, the toddler transition period in which some of them drink large amounts of milk (which interferes with iron absorption) or do not adjust well to a solid/table food diet that has adequate amounts of iron.  A second "peak" age for iron deficiency is noted in teenagers, particulary in teenage girls, whose menstrual cycles can be a source of blood loss coupled with a poor, low iron diet.   I recently  read an article about iron deficiency in teens that touted the effectiveness of iron-fortified breakfast cereals as a source of iron.  Many teenagers may be willing to eat breakfast cereal several times a day, as opposed to taking oral iron tablets.  I have included a list of cereals below.

Oral iron medication can be pretty distasteful, so much of our education in the office is spent stressing foods that either help iron absorption or foods that contain large amounts of iron.  For some "picky" children,  this can sometimes be difficult.  Teenagers may be able to tolerate oral iron tablets, but can sometimes forget to take the medication.  In this group of patients, discussing iron-rich foods is again an important aspect of treatment.
Iron deficiency may be suspected if a child's hemoglobin or hematocrit are low, and a dietary history is suggestive.  If a complete blood count (CBC) is done, the Mean Corpuscular Volume (MCV) will typically be low in iron deficiency, and the Mean Cell Hemoglobin Concentration (MCHC) may also be low.  The Red Cell Distribution Width (RDW), which measures the span of red cell size in circulation will typically be high in iron deficiency.  If further labwork is done to confirm iron deficiency, your provider will typically measure an iron level, as well as transferrin, ferritin and iron percent saturation.

In iron deficiency, oral iron therapy will stimulate new red cell formation in 5-7 days.  Some providers will check a reticulocyte count (which measure the amount of new red blood cells) to confirm the benefit of therapy.  Once someone has been on iron therapy for a month, a repeat blood count can be done (or the more complete CBC - as mentioned above).  Iron therapy is usually continued for a minimum of 3 months.

FOOD SOURCES OF IRON
GOOD - raisins, dried fruits, potatoes with skin, tomato juice
BETTER - oatmeal and breakfast cereals, beans, nuts and nut butters, bread, pasta, cooked spinach, eggs
BEST - beef, fish and shellfish, pork, chicken and turkey

FOODS THAT AID IN IRON ABSORPTION
Foods with Vitamin C can increase the absorption of iron; eat these foods along with iron-rich foods to increase your body's ability to absorb iron
bell peppers, mango, tangerine, oranges and orange juice, papaya, grapefruit, strawberries, broccoli, melon, green leafy vegetables, tomatoes, cabbage

FOODS THAT INTERFERE WITH IRON ABSORPTION
Some foods block iron absorption, and should be eaten at seperate times from iron supplements or iron-rich foods.
milk, cheese, yogurt, coffee, tea, chocolate, blueberries, grapes, popcorn, tofu

IRON-RICH BREAKFAST CEREALS
The list of the best cereals based on milligrams of iron present per serving:
General Mills - Total and Total corn flakes, Total raisin bran and cranberry crunch, all Chex (corn, rice, honey nut, multi-bran, frosted), Cheerios yogurt burst or multigrain, Kix
Kellogg's - Crispix, Frosted Mini-wheats, All Bran complete wheat flakes, Product 19, Complete oat bran flakes, Smart Start, Rice Krispies, Shredded Wheat
Malt-O-Meal Puffed Wheat, Puffed Rice, Frosted Mini Spooners, Crispy Rice, Honey Graham Squares, Toasty O's
Kashi Mighty Bites, honey crunch

In my practice, I routinely give patients with iron deficiency a handout with the above foods and cereals listed.   In most cases, changing one's diet can treat iron deficiency effectively without the need for iron medication.