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Iron deficiency is regrettably a common mineral deficiency of early childhood. Symptoms include poor appetite, weight loss, irritability, increased susceptibility to infections, and finally, anemia and pale appearance. Since the first four symptoms are rather nonspecific and common to many kids in the 15-18 month age range anyway, the diagnosis is often missed early on. Anemia doesn't occur until the total body store of iron is quite low, since carrying oxygen to the tissues is the top priority of all. It is now thought that the more severe cases of iron deficiency may suffer permanent brain injury with loss of ultimate IQ points, so this is not a trivial issue.
Iron deficiency is unusual in full term first born children , in breast fed infants especially if supplemented with iron, or in children fed iron-fortified formula. Children at risk are thus premature babies, bottle fed infants on low or no iron formulas or (heaven forfend) whole cow milk in early infancy (or later on if the intake of cow milk is excessive - see milk baby).
A woman has quite a number of years to store up iron in her bone marrow before having her first child. During the third trimester, the fetus loads up iron stores from the mother's supply. Thus iron deficiency is unusual in term first borns because mother's iron stores are generally adequate for the first pregnancy. For the same reason, premature babies are routinely supplemented with iron.
However, early resumption of menstruation (and sometimes mother's reluctance to stay on her iron supplement) may lead to a situation of relative iron deficiency in the mother by the time of the next conception. Thus the second or third born child is at a somewhat higher risk for iron deficiency.
The type of milk in the child's diet is important as regards the child's iron status, too. Cow milk binds iron tightly to itself and most of the iron, even in iron fortified formula, is bound to stool protein residues that aren't absorbed. Thus another risk factor stems from the persistent mythology about iron in infant formulas. Every ill conceivable in babies gets blamed on the iron in the formula at one time or another. Of course, this is mythology and nothing more. There have been numerous scientific studies that have proven that the tiny amount of iron in infant formula (1.8 milligrams per 5 ounces of formula) produces absolutely no symptoms in the babies whatsoever except health. It is highly inadvisable to feed your baby low iron or iron free formula. I personally would consider suspect the judgement of a physician who recommended prolonged feeding of iron-poor formula or who advised whole cow milk to young infants. Fortunately, iron poor formulas are being withdrawn from the US market, and not a minute too soon.
Breast fed babies are lucky. Whereas the majority of a bottle fed baby's iron intake winds up in the diaper because it isn't absorbed, mother's milk contains a special protein, lactoferrin, which binds up whatever iron is in the breast milk and transfers it into the baby's system with minimal loss in the stool.
Note as well that iron deficiency does not occur solely in infancy. Older children can suffer its effects as well. Recent research1 has identified the possibility of lower academic function in iron deficient school age children, especially adolescent girls.
1. Pediatrics 2001;107,1381-1386.