In Australia the prevalence of iron deficiency in children under the age of 5 is about 8% [1]. Iron is the most frequent nutritional deficiency around and the earlier it is picked the better. Parents of fussy eaters often wonder if their child is getting enough of this crucial mineral and they should because iron is bloody important!
The catch-22 of Iron deficiency in Fussy Eaters
When a fussy eater has an iron deficiency, their appetite decreases. This can make it difficult for children to eat enough iron-rich foods, such as meat, beans, and leafy green vegetables, which can worsen the deficiency.
In addition, iron deficiency can also affect the taste and enjoyment of food. Some studies suggest that iron-deficient children have a reduced sense of taste, making food less appealing. They may also experience a condition called “pica,” where they crave and eat non-food items, such as dirt or ice, which can further reduce their appetite for nutrient-dense foods.
This vicious cycle of iron deficiency, decreased appetite, and reduced enjoyment of food can be difficult to break. It’s important to check your child’s iron status if there are any concerns.
Why is Iron so Important?
Iron is a mineral essential to haemoglobin, the substance in red blood cells that carries oxygen throughout the body. A prolonged iron deficiency, particularly in infants and young children, can have serious consequences on their physical and cognitive development, in severe cases, it can lead to developmental delays. Studies have shown that iron-deficient children have lower scores on cognitive tests and have difficulty with tasks that require attention and memory. Iron is also a key nutrient for a well functioning immune system.
Low Iron or Anaemia?
Low iron, also known as iron deficiency, is a condition in which the body does not have enough iron to produce enough haemoglobin, the protein in red blood cells that carries oxygen to the body’s tissues. Symptoms of low iron in children can include:
- Pale Skin: Children with iron deficiency may have a pale or washed-out complexion
- Pale Nail Beds: The nail beds of the fingers and toes may appear pale, or even white.
- Brittle Nails: Iron deficiency can also cause brittle, thin, or spoon-shaped nails that curve upward.
- Hair Loss: Iron-deficient children may experience hair loss, and their hair may become brittle, dry, and dull.
- Fatigue and Weakness: Children with iron deficiency may appear lethargic, fatigued, or weak.
- Dark Circles Around the Eyes: Iron deficiency can cause dark circles around the eyes or make them appear sunken
- Mouth Ulcers: Children with iron deficiency may develop sores or ulcers inside their mouths.
- Difficulty concentrating and or irritability.
- Slow healing of wounds.
Anaemia, on the other hand, is a condition in which the body does not have enough red blood cells or haemoglobin. Anaemia can be caused by a variety of factors, including iron deficiency, but can also be caused by other nutrient deficiencies, chronic illnesses, or blood loss. Symptoms of anaemia in children can include all of the above as well as shortness of breath, and a rapid heartbeat, as well as PICA, see above.
It’s important to note that while low iron and anaemia can have similar symptoms, they are not the same condition and require different treatments. A doctor can perform a blood test to determine if a child has low iron or anaemia, and then provide the appropriate treatment, which may include iron supplements or other medications.
If a child displays such symptoms it is important to consult a GP who will investigate. Parents should not supplement iron without advice as too much iron can cause complications, including constipation, stomach cramps, etc.
Causes for Iron Deficiency
The most common cause of deficiency is a lack of iron in the diet, but there are other causes a doctor can investigate, such as an inability to absorb iron (e.g celiac disease). Extreme Fussy Eaters who often do not eat a varied diet and shun meat, and toddlers who drink too much milk, (500ml x 24 hours)[2] are at risk of lacking iron.
Types of Iron and Absorption
There are two types of iron:
- haem iron which is found in meat (the darker the richer), and fish, is easily absorbed.
- Non-haem iron which is found is plant-food and egg, requires vitamin C to enhance absorption. Vitamin C is found in fresh fruit and vegetables.
- Cooking is an cast-iron pan may increase iron in food. Acidic foods like tomatoes, vinegar, citrus juices, and wine, when cooked in a cast iron pan, can absorb more iron. Additionally, the longer the food is cooked in the pan, the more iron it will absorb.
- Tannins and phytates in food and drinks will decrease iron absorption.
Sources of iron
- Meat, the darker the meat is the richer (Offal, black pudding, beef, lamb, chicken, veal, pork),
- Fish and seafood (clams, oysters, sardines, tuna, shrimps etc),
- Green leafy vegetables (Spinach, kale, collards…),
- Wholegrain, wholemeal cereals (wheat, rice etc), iron-fortified bread,
- Beans,
- Soy,
- Chickpeas,
- Egg,
- Sweet potato and potato with skin
- Seeds and nuts (pumpkin seeds, cashew, almonds…),
- Fortified breakfast cereals (weetbix, oatmeals., corn flakes, check the labels),
- Dry fruit.
Iron and ADHD behaviour
Several studies have shown that iron deficiency can contribute to the symptoms of ADHD. Therefore, it is important to consider iron status in the evaluation and management of children with ADHD. A study published in the Journal of Paediatric Psychology in 2009 found that iron supplementation improved cognitive and behavioural functioning in children with ADHD and iron deficiency. The study found that iron supplementation led to improvement in attention, fine motor coordination, and working memory. A recent study published in the Journal of Child Neurology in 2020 showed that iron deficiency anaemia is a risk factor for ADHD, and that anaemia, in addition to iron deficiency, may be related to the severity of ADHD symptoms.
- Hyperactivity: Children with both anaemia and ADHD may exhibit more hyperactive behaviour than those with ADHD alone. This could manifest as increased fidgeting, restlessness, and impulsivity.
- Inattention: Anaemia may exacerbate symptoms of inattention in children with ADHD. They may have an even harder time focusing on tasks or following instructions, which can affect academic performance and daily activities.
- Emotional dysregulation: The presence of anemia may also contribute to mood swings and emotional dysregulation in children with ADHD. They may be more irritable or prone to emotional outbursts, which can affect their relationships with peers and family members.
The study also found that iron supplementation improved some of the symptoms of ADHD. If your extreme fussy eater has a diagnosis of ADHD, make sure that your GP checks iron levels.
Iron and mental health
What are the recommendations ?
Recommended Dietary Intake (RDI) in mg per day.
- Infants from 7-12months: 11mg
- Girls and boys 1-3 years: 9mg
- Girls and boys 4-8 years: 10mg
- Girls and boys 9-13 years: 8mg
- Boys 14-18 years: 11mg
- Girls 14-18 years: 15mg
Children who eat a great variety of foods, should have no problem getting the iron they need from their diet. For fussy eaters, offering fortified cereals makes a lot of sense, each meal should provide sources of iron, even when if children do not always eat them. If in doubt always talk to you doctor or dietitian.
I want to make my family fussy eater free!
- [1]https://www.rch.org.au/clinicalguide/guideline_index/anaemia/
[2]https://www.rch.org.au/kidsinfo/fact_sheets/Nutrition_babies_toddlers/ - American Journal of Clinical Nutrition – “Iron deficiency anemia and cognitive development” by L.F. Caulfield and S. Zavaleta (2000)
- The Journal of Nutrition – “Iron and cognitive development in children” by R.A. Gibson and J.C. Thompson (2005)
- The Lancet – “Iron-deficiency anaemia” by N.S. Scrimshaw and G. Sanghvi (1967)
- The Journal of Pediatrics – “Iron deficiency anemia and cognitive development in children” by L.F. Caulfield and S. Zavaleta (1999)
- Nutrients – “Iron Deficiency Anemia and Cognitive Development in Children” by L.F. Caulfield, M. De Onis, and S. Blössner (2013)
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