Clerkship Ready: Pediatrics

Iron deficiency is the most common nutritional deficiency that occurs in children in United States. Iron plays a vital role in cellular function in all organ systems. Today, we will be reviewing what you need to know before you first see a patient with possible iron deficiency. We will discuss why iron is so important, when and why iron deficiency occurs, screening, diagnosis, and treatment for iron deficiency.

1. Importance of Iron
   
   
   1. Iron and Hemoglobin
   
   
   2. Iron and Neurodevelopment
   
   
   3. Iron and the Immune System
   
   



2. What happens in iron deficiency


3. Reasons that children are at high risk for iron deficiency
   
   
   1. Rapid Growth .
   
   
   2. Insufficient dietary intake and limited absorption
   
   
   3. Increased losses
   
   



4. Peaks of Incidence


5. Other risk factors for iron deficiency.
   
   
   1. Preterm infants
   
   
   2. Children who suffer from neuro-motor disorders as they often have nutritional deficiency related to swallowing impairment
   
   
   3. G.I. diseases that cause malabsorption,
   
   
   4. Diseases predisposing them to bleeding.
   
   
   5. Lead toxicity.
   
   



6. Screening for IDA
   
   
   1. History: Asking about prematurity, low birth weight, exclusive breastfeeding beyond 4 months of age, weaning to whole milk without addition of iron rich foods, feeding problems, and any past medical conditions.
   
   
   2. Exposure to lead (i.e. age/ condition of home, recent renovations, a parent who has occupational exposure, concerns about drinking water).
   
   
   3. Any possible symptoms of anemia, such as fatigue, breath holding spells, pica
   
   
   4. Physical exam: pallor.
   
   
   5. Lab testing.
   
   



7. Treatment for iron deficiency
   
   
   1. Oral iron: daily dose of 3 to 6 mg per kilogram of elemental iron divided into three doses is adequate.
   
   
   2. Give iron supplements with juice - increases iron absorption through the action of ascorbic acid! Juices that are high in ascorbic acid include orange and apple juice.
   
   
   3. Supplements should be continued for a minimum of three months to reestablish iron stores. After completion of treatment, reassessment of iron status
   
   
   4. In addition to iron supplementation, the other aspect of treatment is encouraging dietary intake of iron rich foods (meat and fish, cereals, legumes, vegetables, soy, eggs)
   
   



8. Follow up

Resources/Links:

• Baker RD, Greer FR, et al. Clinical Report – Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0-3 years of age). Pediatrics. 2010; 126(5). www.pediatrics.org/cgi/doi/10.1542/peds.2010-2576


• Özdemir N. Iron deficiency anemia from diagnosis to treatment in children. Turk Pediatri Ars. 2015 Mar 1;50(1):11-9. doi: 10.5152/tpa.2015.2337. PMID: 26078692; PMCID: PMC4462328.


• Lozoff B, Beard J, Connor J, Barbara F, Georgieff M, Schallert T. Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutr Rev. 2006 May;64(5 Pt 2):S34-43; discussion S72-91. doi: 10.1301/nr.2006.may.s34-s43. PMID: 16770951; PMCID: PMC1540447.


• Yadav, D., Chandra, J. Iron Deficiency: Beyond Anemia. Indian J Pediatr 78, 65–72 (2011). https://doi.org/10.1007/s12098-010-0129-7