Clinical Reference Systems: Pediatric Advisor 10.0

Iron in red blood cells carries oxygen to all parts of the body. When children don't get enough iron, they may look pale, act cranky, and not have much energy. Iron-deficiency anemia is the most common nutritional problem children have.

See Iron Deficiency Anemia

You can, however, prevent anemia without much trouble by following these guidelines:

1. Breast-feed your baby or give iron-fortified formula.

2. Start giving your baby iron-fortified infant cereal by the age of 6 months.

3. Teach your child to eat solid foods so he doesn't just drink milk.

   See Solid (Strained) Foods

4. Take some moderate care in planning your child's menu.

5. Serve nutritious food at snack time. Snacks shouldn't be just treats that provide calories with few other nutrients.

   See Snacks for Children

IRON CONTENT OF FOODS

Children need 6 to 10 milligrams (mg) of iron per day. Except for milk, the foods listed in this chart offer significant amounts of iron.

 
       Food                    Amount      Iron (mg) 
----------------------------------------------------
Meat and other protein: 
  Beef, pork, lamb            3 ounces    2 to 3 
  Poultry                     3 ounces         1.5 
  Beef or chicken liver       3 ounces         8.5 
  Calf liver                  3 ounces        14 
  Pork liver                  3 ounces        25 
  Clams                       3 ounces         5 
  Oysters                     3 ounces        13 
  Other fish, shellfish       3 ounces    1 to 1.5 
  Nuts                        2 Tbsp           1 
  Seeds (sunflower, squash, 
     pumpkin)                 2 Tbsp           2 

Breads and cereals: 
  Enriched or whole-grain 
    bread                     1 slice          0.7 
  Noodles, spaghetti, etc.    1/2 cup          0.7 
  Cooked or dry cereals       1/2 to 3/4 cup   0.7 
  Vitamin- and iron-          Iron content varies; 
   supplemented cereals           read package 

Fruits and vegetables: 
  Green, leafy vegetables     1/2 cup          2 
  Peas, mixed vegetables      1/2 cup          2 
  Other vegetables, average   1/2 cup          0.8 
  Prunes and dates            1/2 cup          2 
  Other fruits and juices     1/2 cup          0.6 

Milk: 
  Whole, skim, 2% milk        1 cup            0.1 

Miscellaneous: 
  Blackstrap molasses         1 Tbsp           3 
  Sorghum                     1 Tbsp           2.5 
  Molasses                    1 Tbsp           1 
----------------------------------------------------

OTHER STRATEGIES FOR ADDING IRON TO THE DIET

The problem with iron is that it is difficult for the body to absorb. Iron in meat, poultry, and fish is absorbed several times better than iron from vegetable sources. Animal protein contains something called meat factor, which improves absorption of vegetable iron eaten at the same time as meat. Vitamin C helps iron absorption, too. If your child eats foods rich in vitamin C at the same time as foods rich in iron, the iron will be absorbed better. Examples of meals that have both meat and vitamin C include hamburgers and coleslaw, spaghetti with meat and tomato sauce, hot dogs and orange wedges, and chicken with broccoli.

EGGS, MILK, AND LIVER

Iron in egg yolk is poorly absorbed. In fact, unless you have some vitamin C at the same time you eat an egg, egg yolk will keep iron from being absorbed from other foods. Milk is low in iron (anemic children used to be called milk babies). Milk neither enhances nor blocks iron absorption from other foods.

Liver is an excellent source of iron. However, if your child eats too much liver, she will get too much vitamin A. If you serve liver, serve it only twice a month.

GETTING CHILDREN TO EAT FOODS RICH IN IRON

Have regular meals and snacks, keep control of the menu, and offer children a variety of foods. Then wait. If you try to force children to eat nutritious food, they won't like it and most won't eat it. All you can do is offer good food, have regular meals and snacks, and make eating pleasant.

See Eating Basics: Helping Your Child Eat Well

Typically, iron-rich foods are challenging for children. For example, green, leafy vegetables have a strong flavor. Eat and enjoy them yourself, and after a while your child will try them and maybe even learn to like them. Meat can be hard to chew and swallow. Make meat moist and tender.

CALL YOUR CHILD'S PHYSICIAN DURING OFFICE HOURS IF:

• Your child consistently appears pale, listless, and cranky.
• Your child consistently eats a diet low in iron.