Heart and Blood Conditions

Iron-Deficiency Anemia

What is iron-deficiency anemia?

Anemia happens if the level of red blood cells or hemoglobin in the blood drops below normal. Hemoglobin (HEE-muh-glow-bin) is an iron-rich protein that carries oxygen from the lungs to the rest of the body.

If your child does not have enough iron (iron deficiency), their body cannot make enough hemoglobin. If there’s not enough hemoglobin, cells can’t get enough oxygen.

The anemia can vary from mild to severe.

  • The most common reason for anemia in children is not getting enough iron in the food they eat.

    Other causes of iron-deficiency anemia are:

    • Heavy bleeding during a girl’s menstrual periods.
    • Bleeding inside the body. Internal bleeding may happen if your child has a condition like inflammatory bowel disease or often takes medicines that make their stomach lining bleed. These include nonsteroidal anti-inflammatory drugs such as ibuprofen.
    • Not being able to absorb enough iron from food. This can happen if your child has a disease of their intestine (such as Crohn’s disease or celiac disease) or takes medicine that reduces acid in the stomach.
    • Losing blood because of an accident or surgery.
    • Being exposed to lead by breathing in or eating dust from soil or paint that contains lead. Lead in the blood makes it harder to make hemoglobin.

    • Any child with a diet that doesn’t include enough iron.
    • Babies and teens because they are growing quickly and need more iron.
    • Girls and young women who have heavy periods.
    • Young children who drink a lot of cow’s milk, which is low in iron. Too much milk can make it harder to absorb iron from other foods. It also may take the place of foods that are higher in iron.
    • Babies older than 6 months whose only food is breast milk. The iron that babies have stored in their bodies at birth is used up by 6 months. Breast milk does not have much iron.
    • Babies who were born early (premature) or with a low birth weight. They have lower stores of iron in their body at birth, so will use them up early and need extra iron sooner.
    • Vegetarians who do not eat foods high in iron. The iron in meat is easier to absorb than the iron in plant foods.

Iron-Deficiency Anemia at Seattle Children’s

At Seattle Children’s, we offer a full range of services for babies, children and teens with iron-deficiency anemia.

Experts at our Cancer and Blood Disorders Center focus on diagnosing and treating blood disorders in kids. We work with you, your child, your family and your child’s primary doctor to get your child the right care and services.

Please contact the center at 206-987-2106 for more information, a second opinion or to make an appointment.

  • Our doctors are nationally known for treating children who have blood disorders. The doctors who guide your child’s care (pediatric hematologists) have special training and experience to give the expert care your child needs. They constantly expand their knowledge about blood disorders and the latest research.

    Our doctors are skilled at telling this type of anemia from other types.

    Our doctors can help find out if some other condition, like inflammatory bowel disease, is affecting your child’s iron level. If your child needs care for some other illness, we can help connect you and your child’s primary doctor to other specialists.

  • We carefully monitor your child’s health and provide treatments as needed. We offer the most advanced care in the region, including nutrition guidance, medicines and blood transfusions.

    Seattle Children’s has the experts to treat health problems that severe anemia may cause. These may include infections, heart problems or slowed growth.

    We care for your whole child. We don’t just treat their disease. As needed, your child’s team will include child life specialists; social workers; and experts in nutrition, pharmacy and emotional health. Read more about the supportive care we offer.

  • Our specialty is treating children’s conditions while helping them grow up to be healthy and productive. U.S. News & World Report consistently ranks Seattle Children’s among the best children’s hospitals in the country. In 2017, our program was ranked #1 in the Northwest.

    Children don’t react to illness, injury, pain and medicine in the same way as adults. They need – and deserve – care designed just for them.

    Our doctors have special training in how to diagnose and treat children with blood disorders. Our experts base their treatment plans on years of experience and the newest research on what works best – and most safely – for children.

  • Having a child with iron-deficiency anemia can be stressful. We help take positive steps right away by offering appointments within 1 to 3 days to new patients with urgent needs. If needs are not urgent, new patients can be seen in 1 or 2 weeks.

    During visits, we take time to explain your child’s condition. We help you fully understand your treatment options and make the choices that are right for your family.

    We help your child and your family through the challenges of this condition and connect you to community resources.

    Whether you live nearby or far away, we can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Read about our services for patients and families.

Symptoms of Iron-Deficiency Anemia

If your child’s anemia is mild, you may not notice any symptoms. Most children do not get symptoms unless their anemia is severe.

Your child may be more tired, weak or low-energy than normal. They may seem more fussy or irritable.

Other symptoms of iron-deficiency anemia include:

  • Pale skin, lips or nail beds compared to their normal color
  • Being short of breath, dizzy or lightheaded
  • Headaches
  • Cold hands and feet
  • Rapid heartbeat or irregular heartbeat (arrhythmia)

When anemia is more severe or long lasting, it can lead to other health problems.

Diagnosing Iron-Deficiency Anemia

If your child has symptoms of anemia, the doctor will:

  • Ask about your child’s health
  • Check your child for signs of anemia or other health problems
  • Draw blood and do a test called a complete blood count (CBC)

A CBC checks:

  • The level of red blood cells (hematocrit) and hemoglobin.
  • The size of your child’s red blood cells (the “MCV”). They are usually smaller in iron-deficiency anemia.
  • How many white blood cells and platelets your child has. Abnormal levels may be a sign of infection or another condition.

If the CBC shows that your child has anemia, the doctor may do other tests to learn what’s causing the anemia, how severe it is and the best way to treat it. These may include:

  • Looking at a blood sample under a microscope (peripheral smear) to see if red blood cells look smaller and paler than normal.
  • Checking if your child’s bone marrow is making red blood cells at the correct rate. A blood test called a reticulocyte (re-TIK-u-lo-site) count test measures the number of young, immature red blood cells in your child’s blood.
  • Measuring the actual level of iron in the blood, along with the level of a protein that carries iron in the blood, and how much of your child’s stored iron has been used.
  • Looking for blood in your child’s bowel movement (stool). This can mean there is bleeding in the intestines.
  • Occasionally, other tests may be done to check other body functions, such as liver or kidney tests, or tests for inflammation.

Treating Iron-Deficiency Anemia

After we know for sure that low iron is the cause of your child’s anemia, the doctor can suggest ways to increase red blood cells and hemoglobin to normal levels. Changes in your child’s diet may be enough, but many children will need to take iron.

These are common treatments for iron-deficiency anemia:

    • Eating more foods that contain iron, such as:
      • Meat. All types of meat provide some iron. Beef and liver (from any animal) have the most. Chicken, turkey, pork, lamb, fish and other meats have iron, too.
      • Whole-grain foods or bread, pasta, cereal and other grains with iron added (known as iron-fortified).
      • Eggs.
      • Beans and legumes, like black-eyed peas, chickpeas, green peas, pinto beans and baked beans.
      • Dark-green, leafy vegetables, like spinach, collard greens, kale and broccoli.
      • Peanut butter.
      • Some dried fruits, like dried apricots and dried figs.
      • Yellow fruits and vegetables, like bananas.
    • Eating foods high in vitamin C (like citrus fruit) that help your body absorb iron.
    • Giving less cow’s milk to babies and giving them more iron-rich formula or other foods.

  • For some children and teens, changes in diet are not enough. They may need to take iron supplements or other medicine.

    • Our doctors can advise you about whether your child needs an iron supplement. The doctor will also talk with you about the right amount and how to take it. Taking iron along with vitamin C or certain foods can help your child’s body absorb it better. Too much iron can be harmful, but this rarely happens in children.
    • In severe cases, children may need iron put into their vein by intravenous (IV) tube. Your child can get this treatment without spending a night in the hospital. Our outpatient infusion unit is staffed by expert nurses and is open on weekends.
    • In girls who have heavy periods, birth control pills or other hormone treatments can help reduce bleeding when they menstruate.

  • In rare cases, iron-deficiency anemia can get so severe that a child needs red blood cells from a healthy donor (a blood transfusion). Your child receives the blood through a vein in their arm. Giving your child healthy red blood cells helps them get the oxygen their body needs.

    Most children need to stay overnight in the hospital to get a blood transfusion. Some can get transfusions at our outpatient infusion unit.

Contact Us

Contact the Cancer and Blood Disorders Center at 206-987-2106 for an appointment, a second opinion or more information.

To make an appointment, you can call us directly or get a referral from your child’s primary care provider. We encourage you to coordinate with your pediatrician or family doctor when coming to Seattle Children’s.

Providers, see how to refer a patient.