Iron Deficiency in Infants

Iron deficiency is a medical term used for situations in which there is not enough iron mineral in the body for the systems to function physiologically. Iron deficiency in infants can arise due to many causes. Especially premature (early-born) infants are at risk for iron deficiency. Therefore, while iron supplementation can be started in healthy-born infants together with complementary feeding, in preterm infants iron supplements can be started at the 8th week. If healthy infants are fed formula, formulas enriched with iron should be preferred. For infants fed complementary foods and breast milk, iron-rich foods should be consumed. In addition, foods that increase iron absorption should also be added to the diet.

What Is Iron Deficiency in Infants?

Iron deficiency refers to the situation in which there is not enough iron in the body to carry out the normal physiological processes of organs such as the blood, muscles and brain. The World Health Organization defines iron deficiency for infants as the situation in which serum ferritin is below 12 μg/L. Iron deficiency is a common health problem among infants and children.

What Are the Causes of Iron Deficiency in Infants?

The causes of iron deficiency in infants depend on complex and interrelated factors. For example, iron deficiency in infants is a common condition in premature infants. Because a healthy newborn accumulates eighty percent of the iron present in the body between weeks 28 and 40 of gestation. However, premature infants, because they are born early, do not experience this iron accumulation during this period. Therefore, while the iron stores of healthy infants can last them 6 months, iron support is given to premature infants at an earlier stage. After the sixth month, breast milk alone is no longer sufficient for healthy full-term infants. Therefore, iron-rich foods should be used to start complementary feeding. The causes of iron deficiency in infants are as follows:

Premature birth

Low birth weight

Presence of anemia in the mother

Frequent pregnancies of the mother

Giving cow's milk before 12 months

Low consumption of iron-rich foods

Fluctuations in iron absorption due to intestinal bacteria

Chronic inflammation

Consumption of contaminated food

How Does Iron Deficiency Occur in Infants?

If infants do not take in enough iron into the body, iron stores become insufficient. Low iron stores in turn cause the levels of the proteins ferritin and transferrin to be low. Ferritin is the name given to the storage form of iron. Transferrin is the protein that carries iron to body tissues. If appropriate treatment is not applied during the period when ferritin and transferrin levels fall, it progresses to anemia due to iron deficiency. Iron deficiency can be difficult to notice early, but anemia can be recognized from signs during the infant's routine check-ups.

How Is Iron Deficiency Diagnosed in Infants?

Until iron deficiency anemia develops, the hemoglobin level remains normal. Therefore, it is not detected on complete blood count. Iron deficiency can be diagnosed by performing a separate test for transferrin and ferritin levels. Besides, signs of iron deficiency may not appear in the early period. Therefore, it may not be diagnosed by physical examination alone. Blood parameters used as tests for iron deficiency in infants are as follows:

Serum ferritin: It is a good marker that can be used in diagnosing iron deficiency. However, its level may also rise in inflammation. Therefore, evaluating it together with hemoglobin makes diagnosis easier.

Serum transferrin: It is a parameter that shows the blood's iron-carrying capacity.

Transferrin saturation: It is a test that shows what percentage of the transferrin protein is bound to iron.

Hemoglobin: Because hemoglobin is used in the diagnosis of both anemia and iron deficiency, it is not a specific marker. Evaluating it together with other parameters enables reaching accurate results.

Total iron-binding capacity: It is a test that shows how much free transferrin is available to bind iron in the blood.

Zinc protoporphyrin: It is found in low amounts in red blood cells. However, in iron deficiency and lead exposure, its level increases. Therefore, it can be used as a test that may be useful in diagnosis.

How Is Iron Deficiency Treated in Infants?

For treatment of iron deficiency in infants, first the cause and severity of the disease should be determined. If iron deficiency reaches a severe enough level to cause anemia, drug treatment may be applied. If iron deficiency has not affected hemoglobin levels, sufficient iron intake is provided through nutrition. In addition, mothers need to consume sufficient iron in their diet. Because iron deficiency in the mother also affects her milk. Therefore, the infant may not receive the amount of iron needed from breast milk. The practices that can be applied in the treatment of iron deficiency in infants are as follows:

Infants aged 4 to 6 months should switch to complementary feeding consisting of iron-rich foods.

If the infant has been breastfed for more than 6 months, complementary feeding must be started. Because the iron content of breast milk is sufficient for the baby between 4 and 6 months. After 6 months it may be insufficient.

Up to 12 months of age, cow's milk and other types of milk should not be added to the infant's diet.

Infants who are not breastfed should have iron-containing formulas recommended by the doctor added to their diet.

Especially during the period when the infant transitions to complementary feeding, iron-rich foods should be added to the infant's diet by parents.

Together with iron-rich foods, vitamin C-containing foods such as fruits and vegetables should be consumed. In this way, iron absorption in the body increases.

Routine check-ups should not be neglected in order to evaluate the effectiveness and effects of iron supplementation.

Frequently Asked Questions About Iron Deficiency in Infants

For 1-year-old infants, adding foods high in iron, such as meat, eggs and iron-fortified cereals, to the diet is beneficial. Along with this, adding vegetables and fruits to meals supports vitamin C intake. In this way, the absorption of the iron consumed increases. If iron deficiency causes anemia in the infant, iron supplements may be prescribed. At 2 years of age, infants meet their iron intake only through nutrition. Therefore, the child's nutrition plan should be arranged in a way that is suitable for iron absorption. Beverages that negatively affect iron absorption, such as tea and coffee, should not be given to the child. Choosing freshly squeezed fruit juice at breakfast increases iron absorption. Also, another important cause of iron deficiency development in 2-year-old children is excessive consumption of cow's milk. Therefore, the infant's cow's milk consumption should be kept under control. Supporting the mother with iron supplementation before and after childbirth is beneficial for iron deficiency in infants. If the infant is in a high-risk group for iron deficiency, regular iron checks should be performed. If breastfed, iron supplementation; if formula-fed, iron-rich formulas should be preferred. When the infant is given supplements, check-ups should not be neglected. During the period of starting complementary feeding, information should be obtained from a doctor about factors that increase and decrease iron absorption. Foods that are good for iron deficiency in infants are iron-rich foods such as meat and eggs. Therefore, these foods should be added to complementary feeding. Because nutrition plays an important role in iron deficiency in infants. Iron is an essential mineral for the human body. Therefore, it plays an important role in the development of infants. In particular, it negatively affects motor skills, which are responsible for infants' ability to recognize their environment and communicate. Along with this, among the harms of iron deficiency in infants is that it negatively affects neurodevelopment. Therefore, signs of iron deficiency in infants are evaluated as cognitive and behavioral deficits. Iron deficiency causes loss of appetite, slow weight gain, loss of appetite and pale skin in infants. For checking iron levels in infants, hemoglobin and ferritin levels can be examined. A hemoglobin level below the normal range is a sign of iron deficiency anemia. However, in newborn infants, if the normal ferritin level is below 12 ng/ml, iron deficiency may be mentioned. Hemoglobin being below 2 SD is a sign of iron deficiency anemia. Iron supplementation in infants can be done in different forms. Iron supplementation is performed with iron drops, iron syrup, fortified formula and fortified foods. Iron supplementation in drop form may not be prescribed to all infants. Infants fed only breast milk for the first six months or fed iron-fortified formula do not need iron drops. However, infants who have started complementary feeding after 4 to 6 months may be prescribed iron supplements. However, after starting iron supplementation, the infant should be followed up regularly. Because supplements can cause gastrointestinal disturbances such as nausea, vomiting and constipation. Iron is an essential micronutrient that plays an important role in the development of the infant's brain. In particular, it plays an important role in the production of myelin, the fatty layer that surrounds nerve cells and speeds up the conduction of electrical signals. Some regions of the brain contain densely myelinated nerve cells. Therefore, the iron requirement of infants' brains is high. If iron deficiency develops, insufficient myelination is seen in brain regions of the infant. This condition leads to cognitive and behavioral deficits. This process is one of the events requiring iron in infants. If iron deficiency develops in infants, a decrease in ghrelin hormone level occurs. A decrease in ghrelin hormone level in turn causes loss of appetite. Therefore, iron supplementation given intravenously increases ghrelin hormone levels. In this way, iron medication can increase appetite. There is no specific sign of iron deficiency in infants. However, it can be understood with routine check-ups and with the help of blood tests. Along with this, iron deficiency may be suspected due to complaints such as excessive irritability in the infant, pallor of the skin and loss of appetite. Blood tests are used for definitive diagnosis. Iron deficiency in infants is a problem that professionals can easily detect and treat. Therefore, you can make an appointment for your baby for medical treatment and have them examined before possible complications develop.