Iron Deficiency In Children & Young People

Key points about iron deficiency in children and young people

• iron deficiency is when a child doesn’t have enough iron in their body
• iron is important for growth and development
• eating a variety of foods rich in iron can help prevent iron deficiency
• treatment of iron deficiency usually involves taking iron supplements and eating more iron-rich foods

What is iron deficiency?

Iron deficiency is when your child doesn’t have enough iron in their body. It’s common among tamariki and rangatahi. Iron is important for growth and development. 

Are there different stages of iron deficiency?

There are 2 stages: iron deficiency and iron deficiency anaemia.

Iron deficiency

Iron deficiency happens when your child’s iron levels drop below the normal healthy range. Tamariki and rangatahi can have iron deficiency without anaemia. But, if iron levels stay low, tamariki and rangatahi can get iron deficiency anaemia. 

Iron deficiency anaemia 

Anaemia is when there are low levels of red blood cells or haemoglobin in the body. Haemoglobin is the part of red blood cells that carries oxygen from the lungs to the rest of the body. When there isn't enough iron, the body can't make enough haemoglobin. This is called iron deficiency anemia, which is a common type of anaemia.

What causes iron deficiency in children? 

There are several different reasons why tamariki and rangatahi may have low iron levels. 

Not eating enough iron-rich foods

Iron comes from the food we eat. If tamariki and rangatahi aren’t eating enough iron-rich foods, they may develop low iron levels.

Drinking lots of cow's milk (more than 350 mL per day) can fill tamariki up and limit the amount of iron-rich foods that they eat.

Trouble absorbing iron

Coffee and tea are not recommended for tamariki. They can decrease iron absorption. 

Some medical conditions can make it hard for the body to absorb iron from food. These conditions usually affect the digestive tract, such as coeliac disease and inflammatory bowel disease. 

See the KidsHealth page on coeliac disease to learn more.

See the KidsHealth page on inflammatory bowel disease to learn more.

Rapid growth

Tamariki and rangatahi need more iron during growth spurts.

Conditions causing blood loss

Some rangatahi may develop low iron levels if they have heavy periods. 

Conditions that cause bleeding, like digestive tract problems, can also lead to iron deficiency. If someone loses a lot of blood during surgery or an accident, they can develop iron deficiency too. 

Why is iron important in children?

Iron plays several important roles in the body. 

Tamariki and rangatahi need good levels of iron in their body to:

• help transport oxygen from the lungs to the rest of the body
• support brain development
• provide energy
• support healthy growth 

What are the signs of iron deficiency?

If tamariki and rangatahi have low levels of iron in their body, it can make them feel unwell. Signs of iron deficiency vary depending on how low levels are.

Some of the symptoms include:

• tiredness and feeling weak
• shortness of breath
• fast heartbeat 
• having pale skin
• being irritable and moody
• slower growth and development 
• having trouble concentrating and learning 
• cravings to eat unusual things, like dirt and chalk 

How do I know if my child is iron deficient?

If your child is showing signs of iron deficiency, talk to your health professional. The only way to diagnose low iron is through a blood test.

How can I prevent my child from becoming iron deficient?

Encourage tamariki to have a range of iron-rich foods. Many foods have iron in them. The iron in animal products is easier to absorb than the iron in plant-based foods. But you can boost the absorption of iron from plant-based foods. 

Iron-rich animal products

Animal products with iron include:

• lean beef and lamb
• kidney and liver* 
• shellfish such as mussels and pāua 
• venison
• pork
• chicken
• fish
• eggs 

*Eating a lot of liver can lead to high vitamin A levels. This can be toxic, especially for young tamariki. Limit the amount of liver your child eats. 

Iron-rich plant-based foods

Plant-based foods with iron include:

• breakfast cereals that have been fortified with iron
• legumes, including chickpeas (such as in hummus and falafel), kidney beans and soy beans (such as edamame and tofu)
• nuts (nuts are a choking hazard - use peanut butter or other nut spreads for tamariki under 5)
• breads (particularly whole grain breads)
• vegetables (leafy greens)

Include foods rich in vitamin C

Eating foods rich in vitamin C at the same time as iron-rich foods helps improve iron absorption. Vitamin C rich foods include:

• citrus fruits such as oranges and mandarins 
• kiwifruit
• cauliflower
• broccoli
• taro leaf
• tomatoes
• strawberries

Be careful with drink choices

Coffee and tea are not recommended for tamariki. If rangatahi drink coffee and tea, avoid drinking these with meals. Coffee and tea can decrease the amount of iron absorbed from food. 

For tamariki, limit the amount of cow’s milk they drink to around 350 mL each day. Too much cow’s milk can reduce the amount of iron tamariki get. 

What if my child is vegetarian?

Vegetarian tamariki and rangatahi need a range of iron-rich foods such as:

• iron fortified-breakfast cereals
• legumes including chickpeas (such as in hummus and falafel), kidney beans and soy beans (such as edamame and tofu)
• wholegrain cereal and bread
• dark green leafy vegetables

To help them absorb the iron, serve these foods with fruit and vegetables that are high in vitamin C. 

If you are concerned about your child’s diet, see a health professional. They may suggest seeing a dietitian or registered nutritionist for advice. 

What are the treatment options for iron deficiency?

If your child has low iron, eating iron-rich foods may not be enough to raise their iron levels. Some tamariki and rangatahi may need iron supplements to help increase their iron levels. This will be essential if they have iron deficiency anaemia. Your child's health professional will look for the cause of your child’s low iron and manage that. 

Iron supplements

If your child has low iron levels, their health professional may recommend a course of iron supplements. The dose of iron your child needs will depend on their age. Iron supplements come in liquid and tablet form. Very rarely, tamariki may need an infusion of iron. 

Ferrous fumarate and ferrous sulfate are both commonly used iron supplements in Aotearoa New Zealand that health professionals can prescribe. 

See the page on ferrous sulfate for more information

See the page on ferrous fumarate for more information

See the page on iron supplements for premature and small babies