The issue of iron deficiency in children affects industrialised nations too. It is often due to a lack of variety in the diet, which undermines the healthy development of our young children. Children who drink iron-fortified infant and young children’s formula with iron supplements from six months of age are less affected than those with high cow milk consumption.


Tired, poor con­cen­tra­tion and no in­ter­est in play­ing? Every child has days like this and they quickly pass. How­ever, we need to be care­ful if the oc­ca­sional day turns into sev­eral weeks or months: chronic fa­tigue, con­cen­tra­tion dif­fi­cul­ties and sleep dis­or­ders are fre­quently linked to iron de­fi­ciency in chil­dren.

Ir­re­spec­tive of whether we are young or old, our bod­ies need en­ergy. It is sup­plied by the blood: if we have too lit­tle blood, our body re­ceives too lit­tle oxy­gen. Our phys­i­cal and men­tal per­for­mance is im­paired. We feel list­less and our con­cen­tra­tion is poor. And we need iron to form blood.

Iron is es­sen­tial for chil­dren

For healthy de­vel­op­ment in the growth phase, a child needs as much as 50 per cent more iron than a grown man.(1) And yet be­tween 5 and 20 per cent of all chil­dren under the age of five in in­dus­tri­alised coun­tries have iron de­fi­cien­cies. In the emerg­ing na­tions as many as 50 per cent of chil­dren are af­fected while the fig­ure can be as high as 70 per cent (2, 3) in the de­vel­op­ing world. In in­dus­tri­alised coun­tries, iron de­fi­ciency is mainly due to changed eat­ing habits that often lack va­ri­ety. Our body can­not gen­er­ate iron or store it for long pe­ri­ods so there has to be a reg­u­lar in­take of iron in the form of food. A bal­anced and var­ied diet is there­fore es­sen­tial to meet our iron needs. Meat and ce­real prod­ucts are ex­cel­lent sources of iron, for ex­am­ple. But rather than tak­ing in healthy iron, our young chil­dren fre­quently con­sume too much fat and sugar in the form of fast food, snacks and soft drinks. If a child gains too lit­tle iron in the de­vel­op­ment and growth phase it can lead to health prob­lems, such as mem­ory and at­ten­tion ­deficiency as well as de­pres­sion.(4) And the body suf­fers too. Growth may be im­paired. Tar­geted iron ther­apy (5) can par­tially off­set the phys­i­cal and men­tal deficits. It is there­fore im­por­tant that iron de­fi­ciency is iden­ti­fied and treated at an early stage. Avoid­ing the de­fi­ciency in the first place would be even bet­ter.

Grow­ing chil­dren need lots of iron

Most chil­dren are well sup­plied with iron in the womb and are born with suf­fi­cient lev­els in their sys­tems. How­ever, this sup­ply is de­pleted after 4 to 6 months un­less it is sup­ple­mented by wean­ing foods.

Be­tween the age of 6 to 36 months, the child’s body is in its first crit­i­cal phase with re­gard to lev­els of iron.

The iron con­tent in breast milk falls by half in the first 6 months after birth. How­ever, de­pend­ing on growth lev­els, the amount of blood in a child’s body in­creases sig­nif­i­cantly from 6 months of age. The child now needs a lot of iron to form haemo­glo­bin.(6) At this point it is es­sen­tial to in­clude an iron-rich sup­ple­ment in a child’s diet. Breast­feed­ing is no longer enough on its own and there is lit­tle gain in at­tempt­ing to com­pen­sate for the lack of iron in breast milk by turn­ing to cow’s milk and milk prod­ucts. Nor­mal cow’s milk con­tains very lit­tle iron. If we take a small child who needs 7 mil­ligrams of iron per day then it would need to con­sume 14 litres of cow’s milk in order to reach the rec­om­mended daily amount of iron.(7) The child can eas­ily meet its daily re­quire­ments by drink­ing in­fant or young chil­dren’s for­mula that has been en­riched with iron (be­tween 7 and 12 mil­ligrams per litre, for in­stance).

In­fant and young chil­dren’s for­mula can com­bat iron de­fi­ciency

In gen­eral, chil­dren do not need iron-rich young chil­dren’s for­mula if they are nour­ished in line with the coun­try-spe­cific guide­lines pro­vided by health au­thor­i­ties. Meat, egg yolk and fish are all good sources of iron, as are pulses and whole grain prod­ucts (see table), al­though iron from an­i­mal sources (heme iron) is far more read­ily ab­sorbed by the body than plant (non-heme) iron.

Un­for­tu­nately, there re­mains a huge dif­fer­ence be­tween the­ory and prac­tice. As adults, we often lack the time or the op­por­tu­nity to pre­pare fresh meals for our chil­dren sev­eral times a day. Far too often we give our chil­dren snacks of white bread and high-sugar bis­cuits and choco­late bars, in­stead of of­fer­ing them fruit and a sand­wich on whole­meal bread with veg­eta­bles, cheese or meat fill­ings. They might have a glass of healthy milk but we know cow’s milk only con­tains a lit­tle iron. For lunch or for the evening meal it might be frozen pizza, a plate of in­stant noo­dles or a ready-made meal cooked in the mi­crowave. Ready-made meals are prac­ti­cal but they are not very rich in vi­t­a­mins. If we do use them, it makes sense to give our chil­dren an iron-rich in­fant or young chil­dren’s for­mula. Most stud­ies show that chil­dren who drink in­fant and young chil­dren’s for­mula have higher lev­els of iron than those who only drink cow’s milk.(8, 9)

Yet there can be pit­falls even when a child’s diet is ba­si­cally healthy. Cow’s milk and some veg­etable-based foods con­tain sub­stances known as in­hibitors that de­crease the ab­sorp­tion of iron. These mainly in­clude mag­ne­sium, cal­cium, polyphe­nols and phos­phates. If a child eats ham or an egg, for ex­am­ple, this has lit­tle ef­fect in rais­ing iron lev­els if the child drinks cow’s milk or soya milk with the food. It would be bet­ter for the child to drink a glass of young chil­dren’s for­mula or fruit juice, as vi­t­a­min C helps to re­lease iron from the food.

There are many ways to in­crease the iron con­tent in a meal. In­stead of using cow’s milk, you can add in­fant or chil­dren’s for­mula to chil­dren’s por­ridge or pureed veg­eta­bles for in­stance. It often helps to re­duce our in­take of milk prod­ucts or other iron-in­hibit­ing foods or to pep up ready-made meals with fresh in­gre­di­ents. We owe it to our lit­tle ones.


Further Information


2) Data.Worldbank, Prevalence of anemia among children under 5
3) WHO Global Database on Anaemia
4) Nutrition Reviews® Vol 69 (Suppl). S43 – S48
5) Lozoff B et al: Behavioral and developmental effects of preventing iron deficiency anemia in healthy full-term infants. Pediatrics: 2003;112:846-854
6) Recommendations by the German Society of Pediatrics and Adolescent Medicine (DGKJ)
7) Nutrition Reviews® Vol 69 (Suppl). S37 – S42
8) Smith NJ, Hunter RE. Iron requirements during growth. In: Hallberg L et al. Iron Deficiency. New York: Academic Press; 1970:199-211
9) Woodruff CW et al. The role of fresh cow’s milk in iron deficiency. Am J Dis Child. 1972;124:26-30
10) Brunner S et al. Zentrum für Labormedizin, Kantonsspital Aarau, Schweiz (Centre for Laboratory Medicine, Cantonal Hospital Aarau, Switzerland), Eisenmangel, Gehirnentwicklung und kognitive Leistungsfähigkeit, ARS Medici Dossier 2013
11) Institute of Medicine. Dietary Reference Intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium and zinc. Washington D.C. National Academy Press, 2001.

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