Iron deficiency anemia is the most common form of anemia. Iron is an essential component of hemoglobin, the oxygen carrying pigment in the blood. Iron is normally obtained through the food in the diet and by the recycling of iron from old red blood cells.

Babies are born with about 500mg of iron in their bodies; by the time they reach adulthood they need to have accumulated about 5000mg.

Children need to absorb an average of 1mg per day of iron to keep up with the needs of their growing bodies. Since children only absorb about 10% of the iron they eat, most children need 8-10mg per day of iron. (Breast-fed babies need less, because iron is absorbed 3 times better when it is in breast milk.)

Drinking too much cow's milk is a classic cause of iron deficiency in young children.

A common time for iron deficiency is between 9 and 24 months of age. All babies should have a screening test for iron deficiency at this age. The adolescent growth spurt is another high-risk period.

It can also be related to lead poisoning in children.

• Pale skin color (pallor)
• Fatigue
• Irritability
• Weakness
• Shortness of breath
• Sore tongue
• Brittle nails
• Unusual food cravings (called pica)
• Decreased appetite (especially in children)
• Headache - frontal
• Blue tinge to sclerae (whites of eyes)

Note: There may be no symptoms if anemia is mild.

• Low hematocrit and hemoglobin (red blood cell measures)
• Small red blood cells
• Low serum ferritin (serum iron) level
• High iron binding capacity (TIBC) in the blood
• Blood in stool (visible or microscopic)

Oral iron supplements are in the form of ferrous sulfate. The best absorption of iron is on an empty stomach, but many people are unable to tolerate this and may need to take it with food. Milk and antacids may interfere with absorption of iron and should not be taken at the same time as iron supplements. Vitamin C can increase absorption and is essential in the production of hemoglobin.

Supplemental iron is needed during pregnancy and lactation because normal dietary intake rarely supplies the required amount.

The hematocrit should return to normal after 2 months of iron therapy, but the iron should be continued for another 6 to 12 months to replenish the body's iron stores, contained mostly in the bone marrow.

Intravenous or intra-muscular iron is available for patients when iron taken orally is not tolerated.

Iron-rich foods include raisins, meats (liver is the highest source), fish, poultry, eggs (yolk), legumes (peas and beans), and whole grain bread.

Iron supplementation significantly improves learning, memory, and cognitive test performance in iron-deficient adolescents. Iron supplementation also measurably improves the performance of iron-deficient, anemic athletes.

With treatment, the outcome is likely to be good. In most cases the blood counts will return to normal in 2 months.

Iron deficiency (even when not enough to cause anemia) is an important cause of decreased attention span, alertness, and learning - both in young children and in adolescents. Iron deficiency anemia measurably worsens school performance.

The child's diet is the most important way to prevent and to treat iron deficiency. Many foods are good sources of iron:

• Good -- Tuna, oatmeal, apricots, raisins, spinach, kale, greens, prunes.
• Better -- Eggs, meat, fish, chicken, turkey, soybeans, dried beans, peanut butter, peas, lentils, molasses.
• Best -- Breast milk (the iron is very easily used by the child), formula with iron, infant cereals, other iron-fortified cereals, liver, prune juice.

Also restrict milk to no more than 32 ounces daily. If the diet is deficient in iron, iron should be taken orally. During periods of increased requirements, such as teen pregnancy and lactation, increase dietary intake or take iron supplements.