Iron is one of the most important nutrients of any diet. It has a significant impact on the body’s immunity, and the psychology and mental capacity of children, both in the short-term and the long-term. Despite its importance, iron is also one of the most deficient nutrients in the human body, especially in the first 100 days of life.<sup> 1</sup>
In 2011 alone, 300 million children around the world suffered from iron deficiency.<sup> 2 </sup>This is a serious problem in the Middle East specifically, with 39% of children in Jordan struggling with a lack of iron.<sup> 3 </sup>
Children are more at risk of nutrient deficiency than adults are, because in the first three years of life when they are rapidly growing, the needs of their bodies are at their peak. For those of you who have your own children, or have spent time around children, you can clearly see how quickly they grow.
In fact, a child’s weight triples within their first year of life, and increases fivefold within the first three years. This is why they need so many nutrients, vitamins, and other elements. For example, children need 5.5 times more iron and 7.5 times more Vitamin D than adults do!. <sup>4</sup>
As you might expect, a lack of any of these essential nutrients and elements would be harmful to the growth and immunity of the body, and iron especially has serious long-lasting impacts on children.<sup> 5</sup>
In particular, low levels of iron can affect oxygen circulation, <sup>6</sup> and can result in developmental and behavioral issues that can impact a child’s growth.<sup> 7</sup> Children with iron deficiency tend to show clear signs of emotional and psychological difficulties, including anxiety, unhappiness, social aversion, and difficulty calming down.<sup> 8</sup>
On top of this, there is also a frightening impact on the intellectual abilities of the child, with iron deficiency potentially causing a drop of 8-9 points in IQ and cognition levels. These consequences are difficult to remedy, so children might struggle with them for their entire lives. <sup>9 10</sup>
But we can prevent this from happening. The answer starts with breastfeeding – it is the best way to provide children with nutrients, especially before solid foods are introduced into their diet. In Jordan, where the rate of iron deficiency is concerningly high, only 25% of children are breastfed, which should give you a good idea of the impact of breastfeeding on the health of children. <sup>11</sup>
If breastfeeding can’t be maintained, formula feeding can be used as an alternative if it is supplemented with the necessary nutrients. Along with either breast milk or formula, other foods should also be introduced in a safe and balanced manner. <sup>14 15 16</sup>
It is important to closely monitor the mental and physical development of children, especially during their first three years of live. When breastfeeding is reduced and cow’s milk is introduced, essential nutrients are lost. To avoid this, it is important to consult a pediatrician, or introduce stage 3 formula milk into the diet as, unlike cow’s milk, it has more than enough iron for growth. <sup>12</sup>
Finally, it is important to remember that nutrition should mostly depend on balanced meals with healthy amounts of easily absorbable iron from sources like spinach and red meats for example.<sup> 13</sup>
Dr. Hanaa Damrah
Pediatrician and NeonatologistShow Resources
- Guideline: Daily iron supplementation in infants and children. Geneva: World Health Organization; 2016.
- De benoist B et al, eds Worldwide prevalence of anemia 1993-2005 WHO Global database on Anemia, Geneva , World Health Organisation,2008
- Department of Statistics (DOS) and ICF. 2019. Jordan Population and Family and Health Survey 2017-18. Amman, Jordan, and Rockville, Maryland, USA: DOS and ICF
- Energy- EFSA 2013; Protein- EFSA 2012, Micronutrients- Nordic Nutrition Recommendations 2012
- Rosenthal MJ, Goodwin JS. Cognitive Effects of Nutritional Deficiency. Advances in Nutritional Research 1985.
- Viteri FE, Gonzalez H. Adverse Outcomes of Poor Micronutrient Status in Childhood and Adolescence. Nutrition Reviews 2002; 60(5):S77–S83
- Lozoff et al, 2006; Gunnaraaon et al, 2007
- 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; 64 (5 Pt 2): S34–S91
- Lozoff B, Jimenez E, Smith JB. Double Burden Of Iron Deficiency In Infancy And Low Socio-economic Status: A Longitudinal Analysis Of Cognitive Test Scores To 19 Years. Arch Pediatr Adolesc Med. 2006; 160 (11): 1108-1113.
- Szajewska H, Ruszczynski M, Chmie-lewska A: Effects of iron supplementation in nonanemic pregnant women, infants, and young children on the mental performance and psychomotor development of children: a systematic review of randomized controlled trials.Am J Clin Nutr 2010;91:1684–1690.
- The 2017-18 Jordan Population and Family Health Survey (JPFHS) Department of Statistics (DOS) and ICF. 2019. Jordan Population and Family and Health Survey 2017-18. Amman, Jordan, and Rockville, Maryland, USA: DOS and ICF
- AAFP. Iron Deficiency and Other Types of Anemia in Infants and Children. Available at: ttps://www.aafp.org/afp/2016/0215/p270.html.
- Fewtrell M, Bronsky J, Campoy C, et al. Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2017;64(1):119-132.
- Ahmed T, Hossain M, Sanin KI: Global burden of maternal and child undernutrition and micronutrient deficiencies.Ann Nutr Metab 2012;61(suppl 1):8–17.
- Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, et al: What works? Interventions for maternal and child undernutrition and survival. Lan- cet 2008;371:417–440.
- Bhutta ZA, Rizvi A, Raza F, Hotwani S, Zaidi S, Moazzam Hossain S, et al: A comparative evaluation of multiple mi- cronutrient and iron-folic acid supple- mentation during pregnancy in Pakistan: impact on pregnancy outcomes. Food Nutr Bull 2009;30(4 suppl):S496–S505.
- Bhutta ZA, Haider BA: Maternal micronutrient deficiencies in developing countries. Lancet 2008;371:186–187.
- WHO: Guideline: use of multiple micro- nutrient powders for home fortification of foods consumed by infants and children 6–23 months of age. Geneva, WHO, 2011.
- Peña-Rosas JP, De-Regil LM, Dowswell T, Viteri FE: Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev 12;12:CD004736.
- Bhutta ZA, Das JK, Rizvi A, Gaffey MF,Walker N, Horton S, et al: Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet 2013;382:452-477.
- Ramakrishnan U, Grant FK, Goldenberg T, Bui V, Imdad A, Bhutta ZA: Effect of multiple micronutrient supplementation on pregnancy and infant outcomes: a systematic review.